Individual provider Active NPI

Betty Waddell

  • Family Nurse Practitioner
  • Huntington, WV
National Provider Identifier
1235779802
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
104157 Issued in WV
Practice address
2900 1St Ave Ste 10
Huntington, WV 25702-1241
Phone
(304) 525-6825
NPI assigned
Jan 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 104157 WV Primary

Addresses

Primary practice location

2900 1St Ave Ste 10
Huntington, WV 25702-1241

Mailing address

PO Box 4190
Barboursville, WV 25504-4190

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address betty.waddell@smmm.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20200218000294 WV Practitioner - Nurse Practitioner 4688001449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
JC Edwards School of Medicine, Marshall University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2900 1St Ave
Suite 10
Huntington, WV 25702-1241
Phone (304) 525-6825

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Medical Management, LLC Family CurrentSince Feb 17, 2020 Accepting new patients
St. Mary'S Medical Management, LLC CurrentSince Feb 17, 2020 Accepting new patients

Locations

3075 US Route 60
Huntington, WV 25705
Phone (304) 733-0004

2900 1st Ave
Huntington, WV 25702
Phone (304) 526-1111

2900 1st Ave
Ste 10
Huntington, WV 25702
Phone (304) 525-2495

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1235779802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4190",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255044190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 1ST AVE STE 10",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257021241",
            "telephone_number": "304-525-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "BETTY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-13",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "104157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "betty.waddell@smmm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2900 1st Ave Ste 10",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257021241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.