Provider Demographics
NPI:1275233579
Name:BETTS, KAELYN R (CRNP)
Entity Type:Individual
Prefix:
First Name:KAELYN
Middle Name:R
Last Name:BETTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAELYN
Other - Middle Name:R
Other - Last Name:TINGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-382-5703
Mailing Address - Fax:814-382-5707
Practice Address - Street 1:8507 STATE HIGWAY 285
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-1120
Practice Address - Country:US
Practice Address - Phone:814-382-5703
Practice Address - Fax:814-382-5707
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026874363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner