Provider Demographics
NPI:1851830368
Name:BESONG- MALANGE, BETTY (CNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BESONG- MALANGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL VILLAGE DRIVE.
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-301-2999
Mailing Address - Fax:859-301-2984
Practice Address - Street 1:200 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3408
Practice Address - Country:US
Practice Address - Phone:859-301-2984
Practice Address - Fax:859-301-2984
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.020534363L00000X
KYCNP 3011229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner