Provider Demographics
NPI:1013393537
Name:APPLEBOME, BETHANY MARIE (PA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:APPLEBOME
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-526-1280
Mailing Address - Fax:828-526-1285
Practice Address - Street 1:57 WHITE OWL LN
Practice Address - Street 2:
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717-4514
Practice Address - Country:US
Practice Address - Phone:828-743-2491
Practice Address - Fax:828-743-3060
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1201100OtherGATEWAY HEALTH PLAN
NC19ED1OtherBCBS OF NC
NC7638386OtherPRIME HEALTH SERVICES