Provider Demographics
NPI:1831230754
Name:BECKETT, HEIDI JO (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JO
Last Name:BECKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:107 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-2330
Mailing Address - Country:US
Mailing Address - Phone:402-216-3995
Mailing Address - Fax:
Practice Address - Street 1:2201 N BROADWELL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2153
Practice Address - Country:US
Practice Address - Phone:308-382-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine