MEDICARE: BETHANY ANN SUMPTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	PRSS-5103	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033762125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANN SUMPTER

Provider Business Mailing Address
First Line	:	580 W 5TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-4419
Country	:	US
Telephone Number	:	775-786-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 W 5TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-4419
Country	:	US
Telephone Number	:	775-786-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	06/09/2026

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Directions to “ BETHANY ANN SUMPTER ” Practice Location

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