MEDICARE: BETSY M MOWERY CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	630862	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629053624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY M MOWERY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 2127
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-7127
Country	:	US
Telephone Number	:	903-677-1000
Fax Number	:	903-677-5586

Provider Business Practice Location Address
First Line	:	4534 TRIGGS TRCE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75709-5430
Country	:	US
Telephone Number	:	903-677-1000
Fax Number	:	903-677-5586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	04/30/2014

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