Provider Demographics
NPI:1134112394
Name:CARDER, BETTE (CFNP)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:
Last Name:CARDER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-0190
Mailing Address - Country:US
Mailing Address - Phone:662-634-3089
Mailing Address - Fax:
Practice Address - Street 1:24849 MS HWY 15
Practice Address - Street 2:
Practice Address - City:MATHISTON
Practice Address - State:MS
Practice Address - Zip Code:39752
Practice Address - Country:US
Practice Address - Phone:662-634-3089
Practice Address - Fax:662-634-3063
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR558273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06054271Medicaid
MSQ29031Medicare UPIN
MS06054271Medicaid