Provider Demographics
NPI:1629053624
Name:MOWERY, BETSY M (CRNA)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:M
Last Name:MOWERY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:M
Other - Last Name:MOWERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7127
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:4534 TRIGGS TRCE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75709-5430
Practice Address - Country:US
Practice Address - Phone:903-677-1000
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151481201Medicaid
87751HMedicare PIN
TX151481201Medicaid
8L18983Medicare PIN
8L20589Medicare PIN