=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548823966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. BETHANY JEANETTE FOSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2019
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213B W MASON ST
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64076-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-339-5526
-----------------------------------------------------
Fax | 816-207-0558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213B W MASON ST
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64076-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-339-5526
-----------------------------------------------------
Fax | 816-207-0558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2014019792
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------