Provider Demographics
NPI:1508264946
Name:HAMMON, BECKY SUE (FNP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:SUE
Last Name:HAMMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-1031
Mailing Address - Country:US
Mailing Address - Phone:314-996-7014
Mailing Address - Fax:314-273-0140
Practice Address - Street 1:3009 N BALLAS RD STE 383C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2324
Practice Address - Country:US
Practice Address - Phone:636-484-5277
Practice Address - Fax:314-273-0140
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF1114403363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner