Healthcare Provider Details

I. General information

NPI: 1821240904
Provider Name (Legal Business Name): BETHANY M SWEET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 INTELCO LOOP SE STE 205
LACEY WA
98503-5117
US

IV. Provider business mailing address

PO BOX 944
EAST OLYMPIA WA
98540-0944
US

V. Phone/Fax

Practice location:
  • Phone: 360-472-4785
  • Fax: 360-299-6116
Mailing address:
  • Phone: 360-472-4785
  • Fax: 360-299-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberMD60155686
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60155686
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: