Individual
MR. TROY PATRICK BETTENCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(254) 288-8025
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA06577
STATE LICENSE
TX
Enumeration date
09/29/2008
Last updated
04/25/2019
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