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General NPI Number Information
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NPI Number | 1508379322
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Entity Type | Organization
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Legal Business Name | BETHEL UNIVERSTIY
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 325 CHERRY AVE
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City | MC KENZIE
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State | TN
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Zip | 38201-1769
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Country | US
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Telephone | 972-367-4845
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Fax |
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Provider Business Mailing Address
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Address Line | 15305 DALLAS PKWY STE 800
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City | ADDISON
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State | TX
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Zip | 75001-6415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KRISTY MICHELLE DUNN
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Credential |
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Telephone | 731-352-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24365
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License Number State | TN
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