Provider Demographics
NPI:1235122672
Name:GILBERT, BETHANY (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2418
Mailing Address - Country:US
Mailing Address - Phone:256-232-0636
Mailing Address - Fax:256-232-1058
Practice Address - Street 1:108 SANDERS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2418
Practice Address - Country:US
Practice Address - Phone:256-232-0636
Practice Address - Fax:256-232-1058
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1085474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891008700Medicaid
AL51524842OtherBLUE CROSS BLUE SHIELD
AL51524842OtherBLUE CROSS BLUE SHIELD
P82492Medicare UPIN