Provider Demographics
NPI:1639501539
Name:BETTS, DATANYA Y (NP)
Entity Type:Individual
Prefix:
First Name:DATANYA
Middle Name:Y
Last Name:BETTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8095
Mailing Address - Country:US
Mailing Address - Phone:919-755-2695
Mailing Address - Fax:919-755-7414
Practice Address - Street 1:3126 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8095
Practice Address - Country:US
Practice Address - Phone:919-755-2695
Practice Address - Fax:919-755-7414
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMB2987064OtherDEA