Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F331172-1 | NY |
NPI | 1003862855 |
---|---|
Provider Name | Kimberley A Betker |
First Address | Hornell, NY 14843-9030 |
Second Address | Hornell, NY 14843-9030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01790183 | (05) | NY |
S11132 | (02) | NY |