Individual
CHARLIE BECKNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 254-1814
Mailing address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 254-1814
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21532
KY
207NS0135X
Procedural Dermatology Physician
21532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044793
ANTHEM
—
01
—
0300056
UNITED HEALTHCARE
KY
05
—
64215320
—
KY
01
—
C03007
CUMBERLAND HEALTHCARE
—
Enumeration date
05/31/2005
Last updated
12/16/2013
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