Healthcare Provider Details

I. General information

NPI: 1215861570
Provider Name (Legal Business Name): BETHANY KOELKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALNUT ST BLDG A
RED BLUFF CA
96080-3611
US

IV. Provider business mailing address

1015 OAK GROVE AVE
RED BLUFF CA
96080-4225
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-8491
  • Fax:
Mailing address:
  • Phone: 530-921-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: