Provider Demographics
NPI:1679842561
Name:VANDERVOORT, BETTY (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:VANDERVOORT
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S STEMMONS FWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5390
Mailing Address - Country:US
Mailing Address - Phone:972-434-8000
Mailing Address - Fax:972-434-8001
Practice Address - Street 1:1165 S STEMMONS FWY
Practice Address - Street 2:SUITE 108
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5390
Practice Address - Country:US
Practice Address - Phone:972-434-8000
Practice Address - Fax:972-434-8001
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675170363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care