Provider Demographics
NPI:1700887601
Name:LONGNECKER, BETSY K (CFNP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:K
Last Name:LONGNECKER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 NORTH ROUND BARN ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-939-0931
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-741-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000384A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000976667OtherANTHEM
IN000001050321OtherANTHEM BCBS
OH2445894Medicaid
IN200450860Medicaid
IN200450860Medicaid
INP97019Medicare UPIN
IN000000296329OtherBC/BS # LYNN
IN200450860Medicaid
IN000000296328OtherBC/BS UNION CITY
INP97019Medicare UPIN
IN000000296329OtherBC/BS # LYNN
IL164107Medicare ID - Type UnspecifiedUNION CITY MEDICARE #
IN200450860Medicaid