Provider Demographics
NPI:1467924076
Name:BETTS, KELLY JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:BETTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-2266
Mailing Address - Country:US
Mailing Address - Phone:501-960-6921
Mailing Address - Fax:
Practice Address - Street 1:1601 W. 27TH ST.
Practice Address - Street 2:WNCC HARMS BUILDING
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-632-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112657363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics