Basic Information
Provider Information
NPI: 1477083095
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BETTS
FirstName: ROBYN
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 416 COLEGATE DR BLDG 3
Address2:  
City: MARIETTA
State: OH
PostalCode: 457509549
CountryCode: US
TelephoneNumber: 7405684814
FaxNumber: 7403743165
Practice Location
Address1: 807 FARSON ST STE 136
Address2:  
City: BELPRE
State: OH
PostalCode: 457141068
CountryCode: US
TelephoneNumber: 7404233634
FaxNumber: 7404233635
Other Information
ProviderEnumerationDate: 06/15/2017
LastUpdateDate: 07/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.021380OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAPRN68865WVN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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