Betty J Mirro, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

17702 Issued in TN

Practice address

3085 Fountainside Dr
Suite 202
Germantown, TN 38138-7842

Phone

(901) 755-0550

Fax

(901) 755-0474

NPI assigned

Jul 19, 2005

Last updated

Mar 8, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Betty J Van Hooser Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488931200000",
    "number": "1497754790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 FOUNTAINSIDE DR",
            "address_2": "SUITE 202",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381387842",
            "telephone_number": "901-755-0550",
            "fax_number": "901-755-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 FOUNTAINSIDE DR",
            "address_2": "SUITE 202",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381387842",
            "telephone_number": "901-755-0550",
            "fax_number": "901-755-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRRO",
        "first_name": "BETTY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2017-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "17702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3370933",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "621756596",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETTY",
            "last_name": "VAN HOOSER",
            "middle_name": "J",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vernon A. Miller, M.D.
• Patricia Sue Millikin, ED.D.
• Meghan Mincey, APRN
• Wendy L Mink, FNP-BC
• Keith T Minor, PT
• Abbas Mirza, MD
• Anne Mischke, PHARMD
• Courtney Elizabeth Mitchell, MS, OTR/L
• Helen Bedford Mitchell, FNP, BC
• Michael Mitchell

• Specialist in Germantown, TN
• Providers in Germantown, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.