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NPI Code Detail

MEDICARE: MR. KENNETH J BETHARDS FNP

MEDICARE: MR. KENNETH J BETHARDS FNP
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 PractitionerAPN 710056636AIN

General Provider Information

NPI Number : 1558337832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH J BETHARDS FNP
Provider Business Mailing Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 812-348-0300
Fax Number :
Provider Business Practice Location Address
First Line : 2701 E 3RD ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-5433
Country : US
Telephone Number : 270-748-2786
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 01/10/2023

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