Provider Demographics
NPI:1003600149
Name:BECK, KAILIE (ANPN, FNP-C)
Entity type:Individual
Prefix:
First Name:KAILIE
Middle Name:
Last Name:BECK
Suffix:
Gender:
Credentials:ANPN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3717
Mailing Address - Country:US
Mailing Address - Phone:920-321-6159
Mailing Address - Fax:
Practice Address - Street 1:1740 13TH AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3717
Practice Address - Country:US
Practice Address - Phone:920-321-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16455-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily