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General NPI Number Information
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NPI Number | 1508165374
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Entity Type | Individual
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Provider Name | BETHANY WOOMER
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Gender | Female
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 10/11/2020
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Provider Practice Location Address
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Address Line | 231 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1821
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Country | US
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Telephone | 502-629-4750
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 E CAMELBACK RD STE 250
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City | PHOENIX
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State | AZ
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Zip | 85018-2327
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Country | US
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Telephone | 602-933-1814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 46869
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 46869
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 56170
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 46869
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License Number State | KY
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