Healthcare Provider Details

I. General information

NPI: 1447219324
Provider Name (Legal Business Name): BETSY SMITH MAJMA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

6812 ORCHARD RD
OCEAN SPRINGS MS
39564-2592
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6111
  • Fax:
Mailing address:
  • Phone: 228-818-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number502199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: