Healthcare Provider Details

I. General information

NPI: 1407653579
Provider Name (Legal Business Name): BETHANY LAUREN BEBOUT HRAGYIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 HIGHWAY 280 STE 130
ALEXANDER CITY AL
35010-3375
US

IV. Provider business mailing address

3368 HIGHWAY 280 STE 130
ALEXANDER CITY AL
35010-3375
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-2644
  • Fax: 256-234-2704
Mailing address:
  • Phone: 256-234-2644
  • Fax: 256-234-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-124604
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: