Healthcare Provider Details

I. General information

NPI: 1033870928
Provider Name (Legal Business Name): BETHANY SIMS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S VENTURA AVE STE B
SPRINGFIELD MO
65804-2700
US

IV. Provider business mailing address

1901 S VENTURA AVE STE B
SPRINGFIELD MO
65804-2700
US

V. Phone/Fax

Practice location:
  • Phone: 417-233-1100
  • Fax:
Mailing address:
  • Phone: 417-233-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM21120020
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: