Provider Demographics
NPI:1043988546
Name:BETSY LAYNE PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:BETSY LAYNE PRIMARY CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:MIKALE
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:606-949-1727
Mailing Address - Street 1:83 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:BETSY LAYNE
Mailing Address - State:KY
Mailing Address - Zip Code:41605-7041
Mailing Address - Country:US
Mailing Address - Phone:606-949-1727
Mailing Address - Fax:606-949-1725
Practice Address - Street 1:8324 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MINNIE
Practice Address - State:KY
Practice Address - Zip Code:41651-9008
Practice Address - Country:US
Practice Address - Phone:606-949-1727
Practice Address - Fax:606-949-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health