Provider Demographics
NPI:1346433430
Name:RYBA, BETTY LAURA (MSN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LAURA
Last Name:RYBA
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 98 PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8603
Mailing Address - Country:US
Mailing Address - Phone:228-596-9732
Mailing Address - Fax:601-450-4640
Practice Address - Street 1:56 98 PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8603
Practice Address - Country:US
Practice Address - Phone:228-596-9732
Practice Address - Fax:601-450-4640
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR734406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121027Medicaid
MSS52530Medicare UPIN