Provider Demographics
NPI:1497301139
Name:KING, BETHANY (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KING
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 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:251-625-6897
Practice Address - Street 1:29653 ANCHOR CROSS BLVD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9594
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:251-625-6897
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA07842BOtherMEDICARE PTAN
AL240803Medicaid
ALP02566941OtherRAILROAD MEDICARE