Basic Information
| Provider Information | |||||||||
| NPI: | 1801166509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKMAN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8005 FARNAM DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023904111 | ||||||||
| FaxNumber: | 4023998455 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 E ELKHORN DR | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680256239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027210090 | ||||||||
| FaxNumber: | 4027219661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 10026130600 | 05 | NE | MEDICAID | 10026130606 | 05 | NE | MEDICAID | P01631103 | 01 | NE | RAILROAD MEDICARE | OTHER | 10026130500 | 05 | NE | MEDICAID | 100258006-00 | 05 | NE | MEDICAID | 10026130602 | 05 | NE | MEDICAID | 10026130603 | 05 | NE | MEDICAID | 10026130605 | 05 | NE | MEDICAID | 47063010113 | 05 | NE | MEDICAID | 10026130604 | 05 | NE | MEDICAID |