Healthcare Provider Details

I. General information

NPI: 1619161437
Provider Name (Legal Business Name): BETTINA THOMAS ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTINA COLE ANP-C

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 NAAB RD STE 420
INDIANAPOLIS IN
46260-1992
US

IV. Provider business mailing address

8333 NAAB RD STE 420
INDIANAPOLIS IN
46260-1992
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71002909A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: