Provider Demographics
NPI:1467494914
Name:LAMAR, BETHANY BLANTON (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:BLANTON
Last Name:LAMAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3601
Mailing Address - Country:US
Mailing Address - Phone:256-737-8000
Mailing Address - Fax:256-737-8058
Practice Address - Street 1:1890 AL HIGHWAY 157
Practice Address - Street 2:SUITE 300
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3601
Practice Address - Country:US
Practice Address - Phone:256-737-8000
Practice Address - Fax:256-737-8058
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000096914Medicaid
AL000096914Medicare ID - Type Unspecified
AL000096914Medicaid