Provider Demographics
NPI:1609855493
Name:HENDRICKS, BETSY (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:HENDRICKS
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 1:2425 PRINCE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3746
Mailing Address - Country:US
Mailing Address - Phone:501-327-2967
Mailing Address - Fax:
Practice Address - Street 1:2425 PRINCE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3746
Practice Address - Country:US
Practice Address - Phone:501-327-2967
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69507Medicare UPIN