Provider Demographics
NPI:1750707535
Name:HARRISON, BETSY ANN
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:ANN
Other - Last Name:EL SUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1918 HIKES LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2598
Mailing Address - Country:US
Mailing Address - Phone:502-473-4067
Mailing Address - Fax:
Practice Address - Street 1:1918 HIKES LN STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2598
Practice Address - Country:US
Practice Address - Phone:502-473-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008533363LG0600X, 363LA2200X, 363LG0600X
IN71016244A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health