Healthcare Provider Details

I. General information

NPI: 1386583920
Provider Name (Legal Business Name): BETHANY DAVIS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 CHERRY ST
NORTH WILKESBORO NC
28659-4229
US

IV. Provider business mailing address

282 JONES MORETZ RD
BOONE NC
28607-6268
US

V. Phone/Fax

Practice location:
  • Phone: 336-651-7000
  • Fax:
Mailing address:
  • Phone: 828-434-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1117580
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: