Provider Demographics
NPI:1942401005
Name:BETZ, DONNA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:BETZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:140 STONECREST RD STE 101
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8143
Practice Address - Country:US
Practice Address - Phone:502-928-1060
Practice Address - Fax:502-928-1061
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100090310Medicaid
KYP01228927Medicare PIN
KY7100090310Medicaid