Provider Demographics
NPI:1285215673
Name:DEATON, BETHANY (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DEATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2409
Mailing Address - Country:US
Mailing Address - Phone:903-891-1972
Mailing Address - Fax:
Practice Address - Street 1:1523 BAKER RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2409
Practice Address - Country:US
Practice Address - Phone:903-891-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1172604OtherNCCPA
TXPA14313OtherTEXAS PHYSICIAN ASSISTANT BOARD