Provider Demographics
NPI:1386720241
Name:EDRINGTON, BETTY DIANE (CFNP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:DIANE
Last Name:EDRINGTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TOWER PLAZA
Mailing Address - Street 2:PINEVILLE ROAD
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-575-4374
Mailing Address - Fax:228-575-4303
Practice Address - Street 1:2 TOWER PLAZA
Practice Address - Street 2:PINEVILLE ROAD
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560
Practice Address - Country:US
Practice Address - Phone:228-575-4374
Practice Address - Fax:228-575-4303
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR138400163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05885307Medicaid
MS05885307Medicaid
MS512I500464Medicare PIN
MS830000044Medicare ID - Type UnspecifiedMEDICARE ID #
P00650251Medicare PIN