Provider Demographics
NPI:1457094419
Name:PORTER, BETHANY NOELLE (PMHNP-DNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NOELLE
Last Name:PORTER
Suffix:
Gender:F
Credentials:PMHNP-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2487
Mailing Address - Country:US
Mailing Address - Phone:412-347-1978
Mailing Address - Fax:
Practice Address - Street 1:22 BEAVER ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2487
Practice Address - Country:US
Practice Address - Phone:412-347-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026294363LP0808X
PARN659912163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator