Provider Demographics
NPI:1972557395
Name:KASTAK, BETSY S (NP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:S
Last Name:KASTAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ANIMAS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6972
Mailing Address - Country:US
Mailing Address - Phone:708-828-2157
Mailing Address - Fax:
Practice Address - Street 1:810 E 3RD ST UNIT 301
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5760
Practice Address - Country:US
Practice Address - Phone:970-375-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-263897163W00000X
IL209-005902363LP0200X
COAPN.0992013-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse