Healthcare Provider Details

I. General information

NPI: 1679041743
Provider Name (Legal Business Name): BETHANY MARIE CARTER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST
MARINA CA
93933-6003
US

IV. Provider business mailing address

PO BOX 611
PACIFIC GROVE CA
93950-0611
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax: 831-647-7940
Mailing address:
  • Phone: 209-470-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95014589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: