Provider Demographics
NPI:1740247758
Name:SANDLIN, BETTY DIANNE (CRNA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:DIANNE
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:DIANNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 8411
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8411
Mailing Address - Country:US
Mailing Address - Phone:270-205-5913
Mailing Address - Fax:270-442-1001
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7909
Practice Address - Country:US
Practice Address - Phone:270-205-5913
Practice Address - Fax:270-442-1001
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003065367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00752201OtherRAIL ROAD MEDICARE
KY74001587Medicaid
KY74001587Medicaid
KY00937001Medicare PIN