Provider Demographics
NPI:1437115201
Name:ORANGE, BETTY LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:LOUISE
Last Name:ORANGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:LOUISE
Other - Last Name:FUGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72451-1466
Mailing Address - Country:US
Mailing Address - Phone:870-239-8307
Mailing Address - Fax:870-239-8301
Practice Address - Street 1:1000 W KINGSHIGHWAY STE 4
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-239-8307
Practice Address - Fax:870-239-8301
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0444207V00000X
MOR6P34207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152158004Medicaid
AR200367760OtherTRICARE
AR127460003Medicaid
AR04080021200OtherQUAL CHOICE
F14828Medicare UPIN
AR5J726Medicare ID - Type UnspecifiedINDIVIDUAL
AR5C956Medicare ID - Type UnspecifiedGROUP
AR127460003Medicaid