Provider Demographics
NPI:1639779986
Name:MATHEW, BETSY A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:A
Last Name:MATHEW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 ALLIYAH CT
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7724
Mailing Address - Country:US
Mailing Address - Phone:405-210-1548
Mailing Address - Fax:
Practice Address - Street 1:12716 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-9167
Practice Address - Country:US
Practice Address - Phone:405-769-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily