Healthcare Provider Details

I. General information

NPI: 1558022665
Provider Name (Legal Business Name): BETTY ANN DOBBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 08/26/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 WEST MAIN STREET
ACKERMAN MS
39772
US

IV. Provider business mailing address

1030 WEST MAIN ST 268 PENDERVILLE RD WEIR, MS 39772 (HOME ADDRESS)
ACKERMAN MS
39735
US

V. Phone/Fax

Practice location:
  • Phone: 662-705-3239
  • Fax: 662-705-8795
Mailing address:
  • Phone: 662-285-3239
  • Fax: 662-285-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number905147
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number905147
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905147
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR876207
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR876207
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905147
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: