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NPI Code Detail

MEDICARE: BETHANY PETREY

MEDICARE: BETHANY PETREY
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
1367A00000XAdvanced Practice Midwife09000449CIN
2367A00000XAdvanced Practice Midwife4011242KY

General Provider Information

NPI Number : 1801664479
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY PETREY
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 4001 DUTCHMANS LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4714
Country : US
Telephone Number : 502-893-1270
Fax Number : 502-894-1321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2023
Last Update Date : 12/17/2025

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Directions to “ BETHANY PETREY ” Practice Location

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