Provider Demographics
NPI:1780341826
Name:BECKLEY, MADISON ELIZABETH (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ELIZABETH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1334 CHEROKEE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2252
Mailing Address - Country:US
Mailing Address - Phone:502-523-5591
Mailing Address - Fax:
Practice Address - Street 1:721 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2319
Practice Address - Country:US
Practice Address - Phone:502-583-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty