Provider Demographics
NPI:1437248788
Name:BETHEL, KAREN A (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:BETHEL
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3618
Mailing Address - Country:US
Mailing Address - Phone:954-964-6967
Mailing Address - Fax:954-964-7572
Practice Address - Street 1:1900 N UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3618
Practice Address - Country:US
Practice Address - Phone:954-435-3683
Practice Address - Fax:954-435-2263
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1554662363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301614500Medicaid
FL301614500Medicaid
FLY5705BMedicare ID - Type Unspecified