Provider Demographics
NPI:1275942856
Name:BOATNER, BETHANY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BOATNER
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 1:3401 N CALAIS DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3103
Mailing Address - Country:US
Mailing Address - Phone:903-957-9000
Mailing Address - Fax:903-957-0585
Practice Address - Street 1:3401 N CALAIS DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3103
Practice Address - Country:US
Practice Address - Phone:903-957-9000
Practice Address - Fax:903-957-0585
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant