Healthcare Provider Details

I. General information

NPI: 1346137833
Provider Name (Legal Business Name): KYLIE BETHARDS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E BROADWAY RD
TEMPE AZ
85282-1614
US

IV. Provider business mailing address

1525 S 3600 E
HEBER CITY UT
84032-3512
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax:
Mailing address:
  • Phone: 801-870-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number345526
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number12865571-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: