Provider Demographics
NPI:1568140143
Name:BETTS, MONTANA RYAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MONTANA
Middle Name:RYAN
Last Name:BETTS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1940 IVY WOOD CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8742
Mailing Address - Country:US
Mailing Address - Phone:870-919-3799
Mailing Address - Fax:901-287-5102
Practice Address - Street 1:ULPS
Practice Address - Street 2:850 POPLAR AVE, BUILDING 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-5218
Practice Address - Fax:901-287-5102
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN34177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered