Provider Demographics
NPI:1013912385
Name:POOT, BETSY DALE POOT (ARNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:DALE POOT
Last Name:POOT
Suffix:
Gender:F
Credentials:ARNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 W LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8834
Mailing Address - Country:US
Mailing Address - Phone:360-421-2520
Mailing Address - Fax:
Practice Address - Street 1:1286 W LEISURE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8834
Practice Address - Country:US
Practice Address - Phone:360-421-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006966363LP0808X
ID74514363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health