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NPI Code Detail

MEDICARE: BETTY SIZEMORE APRN

MEDICARE: BETTY SIZEMORE APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3009069KY
2363L00000XNurse Practitioner3009069KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1363L00000XOTHERTAXONOMY

General Provider Information

NPI Number : 1215333133
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY SIZEMORE APRN
Provider Business Mailing Address
First Line : 509 MEMORIAL DR
Second Line : SUITE 2
City : MANCHESTER
State : KY
Zip : 40962-6196
Country : US
Telephone Number : 606-598-5104
Fax Number : 606-598-0983
Provider Business Practice Location Address
First Line : 509 MEMORIAL DRIVE
Second Line : SUITE 2
City : MANCHESTER
State : KY
Zip : 40962-6196
Country : US
Telephone Number : 606-598-5104
Fax Number : 606-598-0983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2014
Last Update Date : 05/30/2019

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