Healthcare Provider Details

I. General information

NPI: 1851222137
Provider Name (Legal Business Name): JARED BETTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LOMBARD ST
BALTIMORE MD
21201-1512
US

IV. Provider business mailing address

900 E FORT AVE APT 629
BALTIMORE MD
21230-5288
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95207460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: