Provider Demographics
NPI:1013690353
Name:BETTIS, KATELYNN SALEEN
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:SALEEN
Last Name:BETTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:SALEEN
Other - Last Name:CRIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 LAURELWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-5204
Mailing Address - Country:US
Mailing Address - Phone:423-414-1113
Mailing Address - Fax:
Practice Address - Street 1:123 LAURELWOOD CIR
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-5204
Practice Address - Country:US
Practice Address - Phone:423-414-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula