Provider Demographics
NPI:1073217782
Name:BETZ, KIERSTEN LEIGH (RT (R), PA-C)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LEIGH
Last Name:BETZ
Suffix:
Gender:F
Credentials:RT (R), PA-C
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:210 FORGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9787
Practice Address - Country:US
Practice Address - Phone:717-254-6109
Practice Address - Fax:717-701-8522
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA064633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1041908190001Medicaid