Provider Demographics
NPI:1952305807
Name:BECKER, MARY B (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:BECKER
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:PLAZA III, SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-896-8660
Practice Address - Fax:502-896-5863
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-05-10
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Provider Licenses
StateLicense IDTaxonomies
KY3002137363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78021375Medicaid
KY78021375Medicaid
KYK004140Medicare Oscar/Certification
KY0614207Medicare ID - Type Unspecified