Provider Demographics
NPI:1255538393
Name:BECKER, WENDOLYN BEA (MD)
Entity type:Individual
Prefix:
First Name:WENDOLYN
Middle Name:BEA
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDOLYN
Other - Middle Name:BEA
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3254
Mailing Address - Country:US
Mailing Address - Phone:816-691-2021
Mailing Address - Fax:816-346-7690
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3254
Practice Address - Country:US
Practice Address - Phone:816-691-2021
Practice Address - Fax:816-346-7690
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018742207L00000X
MO2011006586207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00964001OtherRR MEDICARE
KS200727600AMedicaid
MO1255538393Medicaid
MOP00964001OtherRR MEDICARE