MEDICARE: MELISSA KAY BETHANY DNP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-02864	NM

General Provider Information

NPI Number	:	1770943086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KAY BETHANY DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3102 BARCELONA DR
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-8337
Country	:	US
Telephone Number	:	575-626-9523
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 W 2ND ST STE 1
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-4671
Country	:	US
Telephone Number	:	575-755-7555
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	11/01/2019

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