=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255141289
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY J'NAE FRANK NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2025
-----------------------------------------------------
Last Update Date | 01/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19711 E SMOKY HILL RD
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80015-5194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-459-5634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3478 FIRST LIGHT DR
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-323-7679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN.0999933-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------