Provider Demographics
NPI:1194191247
Name:BETTS, REGINA MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MICHELLE
Last Name:BETTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:MICHELLE
Other - Last Name:SIRCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:12450 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-1901
Practice Address - Country:US
Practice Address - Phone:502-638-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily