Healthcare Provider Details

I. General information

NPI: 1003862855
Provider Name (Legal Business Name): KIMBERLEY A BETKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY A ODELL FNP

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6279 SOUTH HORNELL RD
HORNELL NY
14843-9030
US

IV. Provider business mailing address

6279 SOUTH HORNELL RD
HORNELL NY
14843-9030
US

V. Phone/Fax

Practice location:
  • Phone: 607-661-4800
  • Fax: 607-661-4799
Mailing address:
  • Phone: 607-661-4800
  • Fax: 607-661-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331172-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: