Provider Demographics
NPI:1043737448
Name:GEBUR, BETHANY MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MORGAN
Last Name:GEBUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MORGAN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 E VOREY ST
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745-9619
Mailing Address - Country:US
Mailing Address - Phone:254-258-3361
Mailing Address - Fax:
Practice Address - Street 1:550 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4080
Practice Address - Country:US
Practice Address - Phone:217-422-0311
Practice Address - Fax:217-422-0416
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006286363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical