Individual
MRS. CLEO BECKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
201 RIDGE ST, SUITE 214, COUNCIL BLUFFS, IA 51503-4643
(712) 396-4320
(712) 396-4328
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001350
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026480113
—
NE
05
—
1245223213
—
IA
Enumeration date
08/25/2005
Last updated
05/01/2017
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