Provider Demographics
NPI:1497730063
Name:BETHEL, KNIAKA R (NP)
Entity Type:Individual
Prefix:
First Name:KNIAKA
Middle Name:R
Last Name:BETHEL
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 1:4885 OLENTANGY RIVER RD STE 1-10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1953
Mailing Address - Country:US
Mailing Address - Phone:614-268-6555
Mailing Address - Fax:614-457-5713
Practice Address - Street 1:4885 OLENTANGY RIVER RD STE 1-10
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-268-6555
Practice Address - Fax:614-457-5713
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.08435363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621041Medicaid
OH9283125Medicare PIN
OH2621041Medicaid
OHNP19632Medicare PIN
OHNP19631Medicare PIN
OHNP19633Medicare PIN