Healthcare Provider Details

I. General information

NPI: 1114753092
Provider Name (Legal Business Name): BETHANY JO EARHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

46 CAMPBELL DR
WEST POINT MS
39773-6670
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-1000
  • Fax:
Mailing address:
  • Phone: 662-251-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901952
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: