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General NPI Number Information
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NPI Number | 1851830368
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Entity Type | Individual
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Provider Name | BETTY BESONG- MALANGE CNP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 200 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-3408
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Country | US
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Telephone | 859-301-2984
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Fax | 859-301-2984
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Provider Business Mailing Address
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Address Line | 200 MEDICAL VILLAGE DRIVE.
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City | EDGEWOOD
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-301-2999
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Fax | 859-301-2984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP.020534
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP 3011229
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN173358
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License Number State | GA
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