MEDICARE: BETHANY MCCLEAN RN, CFNP

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	363LF0000X	Family Nurse Practitioner	252859	TX
2	363LF0000X	Family Nurse Practitioner	AP104951	TX

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	:	1639148190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MCCLEAN RN, CFNP

Provider Business Mailing Address
First Line	:	701 E ARBROOK BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-3240
Country	:	US
Telephone Number	:	682-867-1500
Fax Number	:	817-419-1129

Provider Business Practice Location Address
First Line	:	1501 MITCHELL BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-2263
Country	:	US
Telephone Number	:	817-920-6600
Fax Number	:	817-920-6632

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	02/10/2021

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