Healthcare Provider Details

I. General information

NPI: 1255201182
Provider Name (Legal Business Name): ASHLEY GOINS BETHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N CHURCH ST STE 201
GREENSBORO NC
27405-5633
US

IV. Provider business mailing address

1006 CANONERO DR
GREENSBORO NC
27410-3804
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 336-254-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023446
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: