Provider Demographics
NPI:1508559717
Name:ADAMS, BETTY JO
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAHONEY ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-4819
Mailing Address - Country:US
Mailing Address - Phone:307-328-5476
Mailing Address - Fax:
Practice Address - Street 1:201 MAHONEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-4819
Practice Address - Country:US
Practice Address - Phone:307-328-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker