Healthcare Provider Details

I. General information

NPI: 1346437662
Provider Name (Legal Business Name): BETTY J SCHENKEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14588 DUNGANNON RD
BEVERLY OH
45715-9615
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-984-8868
  • Fax:
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.06401-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: