BETTI RAYDEEN WILBURN
NPI 1114386307
Nurse Practitioner - Family in Roswell, GA

Q: What is Betti Wilburn's NPI number?

The NPI number for Betti Wilburn is 1114386307. It was assigned to this individual provider in the NPPES registry on February 16, 2016.

Q: What is Betti Wilburn's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Betti Wilburn was last updated on December 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 16, 2016PECOS Enrolled

900 OLD ROSWELL LAKES PKWY STE 310, ROSWELL, GA 30076(888) 731-8994 Get Directions Write a Review

NPPES record last updated: December 8, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 8, 2024, Dec 10, 2020, Feb 16, 2016 (3 updates tracked since 2016).

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About Betti Raydeen Wilburn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BETTI RAYDEEN WILBURN (NPI 1114386307) is an individual family provider in Roswell, Georgia, licensed in Georgia (RN146147) and active in the NPI registry since February 2016. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1114386307

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameBETTI RAYDEEN WILBURN

Location Address900 OLD ROSWELL LAKES PKWY STE 310Roswell, GA 30076-8667

Mailing Address900 Old Roswell Lakes Pkwy Ste 310Roswell, GA 30076-8667 · (888) 731-8994

Phone(888) 731-8994

Sole ProprietorYes

Enumeration DateFebruary 16, 2016

Last NPPES UpdateDecember 8, 20243 updates tracked since enumeration

NPPES CertifiedDecember 8, 2024

✔ NPI 1114386307 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in GA · RN146147✔ Licensed in GA · RN147136

900 OLD ROSWELL LAKES PKWY STE 310, Roswell, GA 30076

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Secondary Practice Locations 2

Location 13636 S Geyer Rd Ste 100Saint Louis, MO 63127-1237 · Phone (888) 731-8994

Location 2139 Centre St Ph 120New York, NY 10013-4559 · Phone (888) 731-8994

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Betti Raydeen Wilburn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30076 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$100.20 typical visit price

range $18.22 – $140.40

Typical copayment $25.05 (range $4.55 – $35.10)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YVONNE CONAWAY WHNP

Nurse Practitioner (Women's Health)