Healthcare Provider Details

I. General information

NPI: 1437890001
Provider Name (Legal Business Name): BETHANY CAVAN TREIBLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EASTWOOD DR
WALLACE NC
28466-9201
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-2330
  • Fax: 910-267-8995
Mailing address:
  • Phone: 910-293-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023453
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024183680
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: