Provider Demographics
NPI:1316188345
Name:MCNULTY, BETH NICOLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:NICOLE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 SOUTH LIMESTONE EAR NOSE & THROAT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-257-5405
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE E300E EAR NOSE & THROAT CLINIC
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49267207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY49267OtherKENTUCKY BOARD OF MEDICAL LICENSURE