Healthcare Provider Details

I. General information

NPI: 1952206922
Provider Name (Legal Business Name): CALLAN BETHARDS MSN, RN, CEN, PMHNP-
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23832 300TH ST
LEON IA
50144-2897
US

IV. Provider business mailing address

23832 300TH ST
LEON IA
50144-2897
US

V. Phone/Fax

Practice location:
  • Phone: 641-572-0773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number128679
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: