Provider Demographics
NPI:1336387612
Name:BECKER, AMBER M (ARNP-CNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:BECKER
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5731
Mailing Address - Country:US
Mailing Address - Phone:580-379-6140
Mailing Address - Fax:580-379-6149
Practice Address - Street 1:10692 MEDLOCK BRIDGE RD STE 100A
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8497
Practice Address - Country:US
Practice Address - Phone:404-446-2496
Practice Address - Fax:404-446-2497
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA306774363LW0102X
OK73397363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200228350AMedicaid
OK200228350AMedicaid