MEDICARE: BETH ANN DEKONINCK NP-C

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	363LP2300X	Primary Care Nurse Practitioner	71000315A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000372024	OTHER	IN	ANTHEM PROVIDER NUMBER
3	9397614	OTHER	IN	PHCS PID NUMBER

General Provider Information

NPI Number	:	1285693960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN DEKONINCK NP-C

Provider Business Mailing Address
First Line	:	207 E MEADOW RD STE 6
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-3469
Country	:	US
Telephone Number	:	219-204-1854
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 E MEADOW RD STE 6
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-3469
Country	:	US
Telephone Number	:	219-204-1854
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/26/2019

Similar Medicare Providers

1871595082 — CLARENCE HENRY BEAVERS M.D.
Practice Location Address:

207 E MEADOW RD STE 1
EDEN, NC
27288-3469

Practice Phone: 336-627-3194
Practice Fax: 336-627-3208

1477842573 — BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC
Practice Location Address:

207 E MEADOW RD STE 1
EDEN, NC
27288-3469

Practice Phone: 336-627-3194
Practice Fax: 336-627-3208

1780938357 — RICKY L EMERSON
Practice Location Address:

207 E MEADOW RD STE 4
EDEN, NC
27288-3469

Practice Phone: 336-623-2422
Practice Fax: 304-324-8308

1730578402 — JOE GRAY CARPENTER PT, DPT,OCS, FAAOMPT
Practice Location Address:

207 E MEADOW RD STE 3
EDEN, NC
27288-3469

Practice Phone: 336-627-3771
Practice Fax:

1053940882 — ELSA CAMPOS BUCIO FNP-C
Practice Location Address:

207 E MEADOW RD STE 6
EDEN, NC
27288-3469

Practice Phone: 363-864-2795
Practice Fax: 336-694-7511

1649862541 — JARRETT BARTS
Practice Location Address:

207 E MEADOW RD STE 3
EDEN, NC
27288-3469

Practice Phone: 336-627-3771
Practice Fax:

Directions to “ BETH ANN DEKONINCK NP-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.