Individual
BETTY BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
110 29TH AVE N, NASHVILLE, TN 37203-1401
(615) 327-4304
Mailing address
144 MEDICAL CENTER DR, COPPERHILL, TN 37317-5005
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
47514
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009933759
—
AL
05
—
3625345
—
TN
01
—
4112892
BCBS
TN
01
—
620931432
TRICARE REGION SOUTH
TN
05
—
74009796
—
KY
Enumeration date
03/15/2006
Last updated
12/27/2016
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