Provider Demographics
NPI:1245756634
Name:BETHEA, NYKYSHA
Entity Type:Individual
Prefix:
First Name:NYKYSHA
Middle Name:
Last Name:BETHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 GREYSTONE PT APT H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8944
Mailing Address - Country:US
Mailing Address - Phone:336-814-6587
Mailing Address - Fax:
Practice Address - Street 1:3002 GREYSTONE PT APT H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8944
Practice Address - Country:US
Practice Address - Phone:336-814-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant