Healthcare Provider Details

I. General information

NPI: 1477052876
Provider Name (Legal Business Name): BETHANY WHITSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY COLLINS WHITSON FNP-C

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

IV. Provider business mailing address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-6215
  • Fax: 602-639-7830
Mailing address:
  • Phone: 602-639-6215
  • Fax: 602-639-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10981
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224149
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: