Healthcare Provider Details

I. General information

NPI: 1528227899
Provider Name (Legal Business Name): BETTYE PLYLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 EAST REZANOF DRIVE
KODIAK AK
99615
US

IV. Provider business mailing address

3449 E REZANOF DR
KODIAK AK
99615-6952
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-9870
  • Fax: 907-486-9898
Mailing address:
  • Phone: 907-486-9870
  • Fax: 907-486-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2501
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: