Provider Demographics
NPI:1578661765
Name:STEPHENSON, BETSY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:J
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 W DODGE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3451
Mailing Address - Country:US
Mailing Address - Phone:402-955-6877
Mailing Address - Fax:402-955-6880
Practice Address - Street 1:16909 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1521
Practice Address - Country:US
Practice Address - Phone:402-955-7575
Practice Address - Fax:402-955-7555
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1925214Medicaid
IA97571OtherBCBS
NE47068937239Medicaid
NE31389OtherBCBS
NE627OtherMIDLANDS CHOICE