Provider Demographics
NPI:1528363173
Name:KAYE, BETHANEY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:BETHANEY
Middle Name:ANNE
Last Name:KAYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETHANEY
Other - Middle Name:ANNE
Other - Last Name:KUNZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 LINCOLN DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5692
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:414-975-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152287363L00000X
WI4351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner