Provider Demographics
NPI:1457686149
Name:GATHERS, BETTY J (CCCE, CLD, CTSP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:GATHERS
Suffix:
Gender:F
Credentials:CCCE, CLD, CTSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3126
Mailing Address - Country:US
Mailing Address - Phone:727-328-1941
Mailing Address - Fax:727-328-1941
Practice Address - Street 1:2238 22ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3126
Practice Address - Country:US
Practice Address - Phone:727-328-1941
Practice Address - Fax:727-328-1941
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula