Provider Demographics
NPI:1750708335
Name:BRUCE, BETTY S (FNP-BC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:S
Last Name:BRUCE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 S. WIND SONG AVE.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65613-9141
Mailing Address - Country:US
Mailing Address - Phone:417-861-8261
Mailing Address - Fax:
Practice Address - Street 1:3015 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3035
Practice Address - Country:US
Practice Address - Phone:417-621-6634
Practice Address - Fax:417-634-3001
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014003279363LA2200X, 363LF0000X
MO2014113279363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care