Provider Demographics
NPI:1699924993
Name:SCRIVNER, BETTY LOU (MSN, ANPC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:LOU
Last Name:SCRIVNER
Suffix:
Gender:F
Credentials:MSN, ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14307 ROUTE A
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65074-2782
Mailing Address - Country:US
Mailing Address - Phone:573-782-9928
Mailing Address - Fax:
Practice Address - Street 1:14307 ROUTE A
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:MO
Practice Address - Zip Code:65074-2782
Practice Address - Country:US
Practice Address - Phone:573-782-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO059504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425939907Medicaid