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NPI Code Detail

MEDICARE: MRS. BETHANY AMANDA PETERSON NP-C

MEDICARE: MRS. BETHANY AMANDA PETERSON NP-C
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
1363LF0000XFamily Nurse Practitioner1-130643AL
2363LF0000XFamily Nurse PractitionerRN213705GA

General Provider Information

NPI Number : 1144827957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY AMANDA PETERSON NP-C
Provider Business Mailing Address
First Line : PO BOX 776
Second Line :
City : CATAULA
State : GA
Zip : 31804-0776
Country : US
Telephone Number : 706-570-3965
Fax Number :
Provider Business Practice Location Address
First Line : 6228 BRADLEY PARK DR STE A
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-3605
Country : US
Telephone Number : 706-322-1486
Fax Number : 706-324-3419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2020
Last Update Date : 08/22/2025

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