Provider Demographics
NPI:1629355813
Name:BECKER, KELLY NOEL (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NOEL
Last Name:BECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:555 W CROSSTOWN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1982
Mailing Address - Country:US
Mailing Address - Phone:269-585-0200
Mailing Address - Fax:269-337-6108
Practice Address - Street 1:555 W CROSSTOWN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1982
Practice Address - Country:US
Practice Address - Phone:269-585-0200
Practice Address - Fax:269-337-6108
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229883163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse