MEDICARE: BETESSA FAITH FOREMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1141189	KY

General Provider Information

NPI Number	:	1306434782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETESSA FAITH FOREMAN

Provider Business Mailing Address
First Line	:	239 BAKERSFIELD LN
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40744-7910
Country	:	US
Telephone Number	:	808-364-8281
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 SAINT GERMAINE CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3776
Country	:	US
Telephone Number	:	808-364-8281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2021
Last Update Date	:	01/01/2021

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