Provider Demographics
NPI:1073217782
Name:BETZ, KIERSTEN LEIGH (RT (R), PA-C)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LEIGH
Last Name:BETZ
Suffix:
Gender:F
Credentials:RT (R), PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:507-398-0100
Mailing Address - Fax:570-398-4412
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:507-398-0100
Practice Address - Fax:570-398-4412
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA064633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1041908190001Medicaid