Provider Demographics
NPI:1285801571
Name:BETLER, LORI L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:BETLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2630
Mailing Address - Street 2:CENTRAL WV MEDCORP, INC.
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-6302
Mailing Address - Fax:304-637-6307
Practice Address - Street 1:100 SENECA RD
Practice Address - Street 2:TYGART VALLEY ENT ASSOCIATES
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9709
Practice Address - Country:US
Practice Address - Phone:304-637-6302
Practice Address - Fax:304-637-6307
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical