Provider Demographics
NPI:1831209089
Name:BECKNER, KATHY G (PA-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:BECKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:G
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:573-348-8399
Mailing Address - Fax:573-348-8309
Practice Address - Street 1:128 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3257
Practice Address - Country:US
Practice Address - Phone:573-302-3990
Practice Address - Fax:573-302-2753
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP47538Medicare UPIN
MO000097372Medicare PIN