Healthcare Provider Details

I. General information

NPI: 1013393537
Provider Name (Legal Business Name): BETHANY MARIE APPLEBOME PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY MARIE GRIM

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WHITE OWL LN
CASHIERS NC
28717-4514
US

IV. Provider business mailing address

PO BOX 602373
CHARLOTTE NC
28260-2373
US

V. Phone/Fax

Practice location:
  • Phone: 828-743-2491
  • Fax: 828-743-3060
Mailing address:
  • Phone: 828-526-1280
  • Fax: 828-526-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05933
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: