Individual
MR. DOUGLAS WAYNE BECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2000
(859) 301-6910
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-6160
(859) 301-0951
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10395
OH
363L00000X
Nurse Practitioner
Primary
3003519
KY
363L00000X
Nurse Practitioner
71001655A
IN
363LF0000X
Family Nurse Practitioner
10395
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611300608056
CARESOURCE
OH
05
—
78006475
—
KY
01
—
P00873403
RAILROAD MEDICARE
OH
Enumeration date
11/24/2008
Last updated
12/19/2025
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