Healthcare Provider Details

I. General information

NPI: 1154979227
Provider Name (Legal Business Name): BETHANY BARTHOLOMEW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CAPCOM AVE STE 105
WAKE FOREST NC
27587-6517
US

IV. Provider business mailing address

123 CAPCOM AVE STE 105
WAKE FOREST NC
27587-6517
US

V. Phone/Fax

Practice location:
  • Phone: 919-263-8510
  • Fax:
Mailing address:
  • Phone: 919-263-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5012169
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: