Provider Demographics
NPI:1275674707
Name:BETTS, WILMER CONRAD III (FNP)
Entity Type:Individual
Prefix:MR
First Name:WILMER
Middle Name:CONRAD
Last Name:BETTS
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAS CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2414
Mailing Address - Country:US
Mailing Address - Phone:919-531-9168
Mailing Address - Fax:919-654-3800
Practice Address - Street 1:100 SAS CAMPUS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2414
Practice Address - Country:US
Practice Address - Phone:919-531-9168
Practice Address - Fax:919-654-3800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS99840Medicare ID - Type UnspecifiedMEDICARE PART B PROGRAM