Provider Demographics
NPI:1841572575
Name:KEAN, BETSY M (PA)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:M
Last Name:KEAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:M
Other - Last Name:YERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2309
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2309
Mailing Address - Country:US
Mailing Address - Phone:509-454-8888
Mailing Address - Fax:509-453-0061
Practice Address - Street 1:111 S 11TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3273
Practice Address - Country:US
Practice Address - Phone:509-454-8888
Practice Address - Fax:509-453-0061
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60231494363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015046Medicaid