Healthcare Provider Details

I. General information

NPI: 1740247758
Provider Name (Legal Business Name): BETTY DIANNE SANDLIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY DIANNE ANDERSON CRNA

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/25/2024
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
PADUCAH KY
42003-7909
US

IV. Provider business mailing address

PO BOX 8411
PADUCAH KY
42002-8411
US

V. Phone/Fax

Practice location:
  • Phone: 270-205-5913
  • Fax: 270-442-1001
Mailing address:
  • Phone: 270-205-5913
  • Fax: 270-442-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3003065
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: