Provider Demographics
NPI:1437546819
Name:KINSEY, BETHANY ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ELLEN
Last Name:KINSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 WELLSTAR WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9086
Mailing Address - Country:US
Mailing Address - Phone:470-267-0135
Mailing Address - Fax:770-999-2631
Practice Address - Street 1:1120 WELLSTAR WAY STE 204
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30114-9086
Practice Address - Country:US
Practice Address - Phone:470-267-0135
Practice Address - Fax:770-999-2631
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
GAPENDINGMedicaid