Provider Demographics
NPI:1386966117
Name:HARRISON, BETTY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HAMILTON GATE PT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8822
Mailing Address - Country:US
Mailing Address - Phone:501-767-5479
Mailing Address - Fax:
Practice Address - Street 1:108 HAMILTON GATE PT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-8822
Practice Address - Country:US
Practice Address - Phone:501-767-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR310968163WA2000X, 171M00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator