Provider Demographics
NPI:1073879995
Name:WITHERSPOON, BETTENA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BETTENA
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 TIGER WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-7480
Mailing Address - Country:US
Mailing Address - Phone:615-513-3003
Mailing Address - Fax:615-367-1445
Practice Address - Street 1:352 W NORTHFIELD BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1539
Practice Address - Country:US
Practice Address - Phone:615-896-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN156347163WI0500X
TN16193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy