Healthcare Provider Details

I. General information

NPI: 1942479753
Provider Name (Legal Business Name): BETHANY ANN WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY ANN BAUMAN

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

IV. Provider business mailing address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 497-890-2497
Mailing address:
  • Phone: 479-968-2345
  • Fax: 497-890-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-361
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: