Healthcare Provider Details

I. General information

NPI: 1942258272
Provider Name (Legal Business Name): ANGELA DAWN BETHUNE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANGELA DAWN FORD

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 COUNTY ROAD 155
FLAT ROCK AL
35966-9127
US

IV. Provider business mailing address

508 COUNTY RD 155
FLAT ROCK AL
35966-9127
US

V. Phone/Fax

Practice location:
  • Phone: 352-636-4193
  • Fax:
Mailing address:
  • Phone: 352-636-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP1742912
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013540
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-185052
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP000485
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30628
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN268922
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ081665
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier593736126
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerAETNA
# 3
Identifier82127
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBCBS
# 4
Identifier300864900
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: