Provider Demographics
NPI:1467994202
Name:BETTIS, SARAH JANE (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:BETTIS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:HELDSTAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3736 LOCUST ST
Mailing Address - Street 2:APARTMENT 32
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2283
Mailing Address - Country:US
Mailing Address - Phone:785-375-6166
Mailing Address - Fax:
Practice Address - Street 1:3736 LOCUST ST
Practice Address - Street 2:APARTMENT 32
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2283
Practice Address - Country:US
Practice Address - Phone:785-375-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO53-77457-091363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-77457-091OtherAGACNP LICENSE