MEDICARE: MRS. BETHANY DAWN MANNING PA-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	363A00000X	Physician Assistant	PA13470	TX

General Provider Information

NPI Number	:	1528619756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY DAWN MANNING PA-C

Provider Business Mailing Address
First Line	:	1110 PARKER SQ
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-7432
Country	:	US
Telephone Number	:	479-264-0444
Fax Number	:	972-724-1407

Provider Business Practice Location Address
First Line	:	1110 PARKER SQ RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028
Country	:	US
Telephone Number	:	479-264-0444
Fax Number	:	972-724-1407

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

Provider Enumeration Date	:	09/29/2019
Last Update Date	:	12/15/2025

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