MEDICARE: DR. BETHANY ALISE HENDERSON DNP

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	363LF0000X	Family Nurse Practitioner	70995	NM

General Provider Information

NPI Number	:	1215233721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANY ALISE HENDERSON DNP

Provider Business Mailing Address
First Line	:	1141 CAVE SPRINGS TRL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4002
Country	:	US
Telephone Number	:	575-621-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 CAVE SPRINGS TRL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4002
Country	:	US
Telephone Number	:	575-621-1030
Fax Number	:

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

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	01/03/2023

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