Provider Demographics
NPI:1821412396
Name:OSBORN, BETSY MCCULLOCH
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:MCCULLOCH
Last Name:OSBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5393
Mailing Address - Country:US
Mailing Address - Phone:256-799-2500
Mailing Address - Fax:
Practice Address - Street 1:600 WHITESPORT CIR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6495
Practice Address - Country:US
Practice Address - Phone:256-429-5622
Practice Address - Fax:256-429-4618
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129748363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology