Healthcare Provider Details

I. General information

NPI: 1053012633
Provider Name (Legal Business Name): BETHANY JOYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY AMBER JOYAL-COUSIN

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 APPLECREEK RD
SMITHVILLE OH
44677-9720
US

IV. Provider business mailing address

6144 APPLECREEK RD
SMITHVILLE OH
44677-9720
US

V. Phone/Fax

Practice location:
  • Phone: 813-951-5822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: