Provider Demographics
NPI:1720641483
Name:LAWHORNE, BETTY JEAN
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JEAN
Last Name:LAWHORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOPHIE ANN
Other - Middle Name:
Other - Last Name:ASSOCIATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:944 AUGUSTA FARMS RD
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-3201
Mailing Address - Country:US
Mailing Address - Phone:540-941-1823
Mailing Address - Fax:540-949-6907
Practice Address - Street 1:944 AUGUSTA FARMS RD
Practice Address - Street 2:
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477-3201
Practice Address - Country:US
Practice Address - Phone:540-941-1823
Practice Address - Fax:540-949-6907
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101533955171M00000X, 251E00000X, 302R00000X, 251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101533955Medicaid
VA1720641483Medicaid