Healthcare Provider Details

I. General information

NPI: 1922612597
Provider Name (Legal Business Name): BETHANY ALYSE GERBER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 21ST ST FL 6
LUBBOCK TX
79410-1210
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-2263
  • Fax: 806-723-7768
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-725-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1011572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: