Provider Demographics
NPI:1831558451
Name:BECK, CASEY SKYE (CPNP-PC, PMHS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:SKYE
Last Name:BECK
Suffix:
Gender:F
Credentials:CPNP-PC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 OCONEE CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-5957
Mailing Address - Country:US
Mailing Address - Phone:762-218-4312
Mailing Address - Fax:
Practice Address - Street 1:1920 BRIARCLIFF RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-785-8163
Practice Address - Fax:706-788-2815
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN242580363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics