Basic Information
| Provider Information | |||||||||
| NPI: | 1477704062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKWITH | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | B.S.N. R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 3 BOX 36 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740209503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185105562 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1120 S UTICA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185791000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 10/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 93821 | OK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.