Provider Demographics
NPI:1497266902
Name:VALENCIA, BETHANY (FNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N STATE HIGHWAY 123
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7856
Mailing Address - Country:US
Mailing Address - Phone:512-396-3663
Mailing Address - Fax:
Practice Address - Street 1:1400 N STATE HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7856
Practice Address - Country:US
Practice Address - Phone:512-396-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner