=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356394241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY CRITTENDON GLOTFELTY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 BURNETT COURT
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-385-4022
-----------------------------------------------------
Fax | 970-385-4337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 BURNETT COURT
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-385-4022
-----------------------------------------------------
Fax | 970-385-4337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA2013-0028
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA0003731
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------