MEDICARE: BETHANY SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	10009458	OR

General Provider Information

NPI Number	:	1174497580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY SMITH

Provider Business Mailing Address
First Line	:	2217 TEAKWOOD AVE NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-1344
Country	:	US
Telephone Number	:	503-583-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2217 TEAKWOOD AVE NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-1344
Country	:	US
Telephone Number	:	503-583-6366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	10/02/2025

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Directions to “ BETHANY SMITH ” Practice Location

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