Healthcare Provider Details

I. General information

NPI: 1659299923
Provider Name (Legal Business Name): BETHANY A DEAN-STOOTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY STOOTS

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 10TH AVE NE
JACKSONVILLE AL
36265-1747
US

IV. Provider business mailing address

605 10TH AVE NE
JACKSONVILLE AL
36265-1747
US

V. Phone/Fax

Practice location:
  • Phone: 256-425-3196
  • Fax:
Mailing address:
  • Phone: 256-425-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: