Provider Demographics
NPI:1003872938
Name:BETHUNE, KAREN M (ARNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:BLAKE PARK STE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:1850 59TH ST W
Practice Address - Street 2:BLAKE PARK STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-4993
Practice Address - Fax:941-795-2905
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP160923Z363LX0001X
FLARNP1609232363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5584YMedicare ID - Type Unspecified
FLS29620Medicare UPIN