Provider Demographics
NPI:1679847073
Name:BECKMAN, KATHLEEN (PNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 OLDE GREENWICH DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4001
Mailing Address - Country:US
Mailing Address - Phone:540-741-0544
Mailing Address - Fax:540-741-0546
Practice Address - Street 1:4550 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-604-9894
Practice Address - Fax:540-604-9895
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics