Provider Demographics
NPI:1043768005
Name:ROBINETTE, BETHANY AUTRY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:AUTRY
Last Name:ROBINETTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8842
Mailing Address - Country:US
Mailing Address - Phone:601-502-6042
Mailing Address - Fax:
Practice Address - Street 1:10556 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4109
Practice Address - Country:US
Practice Address - Phone:228-539-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily