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NPI Code Detail

MEDICARE: BRIDGET DENISE BETHEA NURSE PRACTITIONER

MEDICARE: BRIDGET DENISE BETHEA NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner0024169131VA
2363LF0000XFamily Nurse Practitioner335325-1NY
3363LP2300XPrimary Care Nurse PractitionerRN221907GA
4363LF0000XFamily Nurse PractitionerAP5151AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376733758
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET DENISE BETHEA NURSE PRACTITIONER
Provider Business Mailing Address
First Line : PO BOX 748860
Second Line :
City : ATLANTA
State : GA
Zip : 30374
Country : US
Telephone Number : 623-433-0106
Fax Number : 623-535-0741
Provider Business Practice Location Address
First Line : 2840 N DYSART RD
Second Line :
City : GOODYEAR
State : AZ
Zip : 85395-2338
Country : US
Telephone Number : 623-536-5310
Fax Number : 401-652-9787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2007
Last Update Date : 08/11/2023

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Directions to “ BRIDGET DENISE BETHEA NURSE PRACTITIONER” Practice Location

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