MEDICARE: KNIAKA R BETHEL N.P.

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.08435	OH

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

General Provider Information

NPI Number	:	1497730063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KNIAKA R BETHEL N.P.

Provider Business Mailing Address
First Line	:	4885 OLENTANGY RIVER RD STE 1-10
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1953
Country	:	US
Telephone Number	:	614-268-6555
Fax Number	:	614-457-5713

Provider Business Practice Location Address
First Line	:	4885 OLENTANGY RIVER RD STE 1-10
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214
Country	:	US
Telephone Number	:	614-268-6555
Fax Number	:	614-457-5713

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	06/27/2018

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