Healthcare Provider Details

I. General information

NPI: 1679945653
Provider Name (Legal Business Name): BETHANY MORRELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LEGATO RD STE 1100
FAIRFAX VA
22033-2893
US

IV. Provider business mailing address

13244 PLEASANT GLEN CT
HERNDON VA
20171-2342
US

V. Phone/Fax

Practice location:
  • Phone: 703-431-4615
  • Fax:
Mailing address:
  • Phone: 703-431-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172876
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500004039
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500004039
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024172876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: