Healthcare Provider Details

I. General information

NPI: 1689337651
Provider Name (Legal Business Name): BETHANY KNIGHTON CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 S 500 E
OGDEN UT
84405-4773
US

IV. Provider business mailing address

1027 E 300 N
BRIGHAM CITY UT
84302-2308
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-5207
  • Fax:
Mailing address:
  • Phone: 208-241-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: