Healthcare Provider Details

I. General information

NPI: 1326673633
Provider Name (Legal Business Name): BETHANY SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 MILITARY CUTOFF RD STE 110
WILMINGTON NC
28403-5748
US

IV. Provider business mailing address

1613 MILITARY CUTOFF RD STE 110
WILMINGTON NC
28403-5748
US

V. Phone/Fax

Practice location:
  • Phone: 910-781-8927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN306491
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011890
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189078
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5021802
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: