Healthcare Provider Details

I. General information

NPI: 1235566548
Provider Name (Legal Business Name): BETHANY ANN ABERNETHY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY ANN COTTINGS PA

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 9016
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 9016
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-8092
  • Fax: 513-803-9245
Mailing address:
  • Phone: 513-803-8092
  • Fax: 513-803-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007581RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-04536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: