Provider Demographics
NPI:1235848417
Name:BETSEY, SHELBY NICOLE (RT(R), CHR)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:BETSEY
Suffix:
Gender:F
Credentials:RT(R), CHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1002
Mailing Address - Country:US
Mailing Address - Phone:918-540-2535
Mailing Address - Fax:
Practice Address - Street 1:118 S EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1002
Practice Address - Country:US
Practice Address - Phone:918-540-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22-054592471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography