Provider Demographics
NPI:1902363153
Name:BETZ, KAREN ROSE (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:BETZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LIVERMORE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7270
Mailing Address - Country:US
Mailing Address - Phone:910-521-8484
Mailing Address - Fax:910-521-9765
Practice Address - Street 1:102 LIVERMORE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7270
Practice Address - Country:US
Practice Address - Phone:910-521-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001008890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant