Individual provider Active NPI

Betsy Lynn Desjarlais, FNP

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1881807790
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4978 Issued in AZ
Practice address
3605 E Thomas Rd
Phoenix, AZ 85018-7505
Phone
(602) 427-0779
Fax
(602) 275-1716
NPI assigned
May 7, 2007
Last updated
Jan 11, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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 4978 AZ Primary

Addresses

Primary practice location

3605 E Thomas Rd
Phoenix, AZ 85018-7505

Mailing address

2311 N 58TH St
Scottsdale, AZ 85257-1911
Phone (719) 963-0633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20140722001451 AZ Practitioner - Nurse Practitioner 3971694977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Circle the CityGroup PAC ID 3971824442, 63 clinicians

Practice addresses (Care Compare)

210 S 12TH Ave
Phoenix, AZ 85007-3101
Phone (602) 254-4282

220 S 12TH Ave
Phoenix, AZ 85007-3101
Phone (602) 258-8282

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4978AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Circle the City CurrentSince Mar 1, 2021 Accepting new patients
Circle the City Current Accepting new patients
Circle the City CurrentSince Mar 1, 2021 Accepting new patients

Locations

210 S 12th Ave
Phoenix, AZ 85007
Phone (602) 254-4282

220 S 12th Ave
Phoenix, AZ 85007
Phone (602) 372-2100

3522 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 776-7676

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1881807790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 N 58TH ST",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852571911",
            "telephone_number": "719-963-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187505",
            "telephone_number": "602-427-0779",
            "fax_number": "602-275-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESJARLAIS",
        "first_name": "BETSY",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "4978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.