Healthcare Provider Details

I. General information

NPI: 1992470710
Provider Name (Legal Business Name): BETHANY JOY HARTER APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRIPLER ARMY MEDICAL 1 JARRET WHITE ROAD /CAFBHS
HONOLULU HI
96859
US

IV. Provider business mailing address

45-131 WAIKALUA RD
KANEOHE HI
96744-2750
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6814
  • Fax:
Mailing address:
  • Phone: 910-286-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN-67616
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-67616
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberAPRN-1267
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-67616
License Number StateHI
# 5
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-1267
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: