Betti Raydeen Wilburn

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN146147 Issued in GA

Practice address

900 Old Roswell Lakes Pkwy Ste 310
Roswell, GA 30076-8667

Phone

(888) 731-8994

NPI assigned

Feb 16, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733616000000",
    "number": "1114386307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 OLD ROSWELL LAKES PKWY STE 310",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300768667",
            "telephone_number": "888-731-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 OLD ROSWELL LAKES PKWY STE 310",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300768667",
            "telephone_number": "888-731-8994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3636 S Geyer Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631271237",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "139 Centre St Ph 120",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100134559",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "BETTI",
        "middle_name": "RAYDEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-16",
        "last_updated": "2024-12-08",
        "certification_date": "2024-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN147136",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN146147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Camden Widder, LPC
• Nicole Widjaja, DMD
• Caroline McLendon Wieler, MS, RDN
• Keonia Wiggins, MS
• Margaret Wilborn, FNP-C
• Elaine Wilco, M.A., L.P.C.
• Megan Marie Wildermuth, NP-C
• Janice Jean Wiles, APRN,BC, FNP-C
• Stephen Elliott Wilhoite, DDS
• Keionna Wilkerson, PA-C

• Family Nurse Practitioner in Roswell, GA
• Providers in Roswell, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.