Provider Demographics
NPI:1538829270
Name:BECKER, KARI BERNICE (APRN)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:BERNICE
Last Name:BECKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:BERNICE
Other - Last Name:WIEGMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9401 HOLY CROSS LN STE 112
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-7271
Mailing Address - Fax:
Practice Address - Street 1:9401 HOLY CROSS LN STE 112
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042609363LF0000X
IL209024192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily