Provider Demographics
NPI:1548580186
Name:SHORT, BETH KESSLER (ARNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:KESSLER
Last Name:SHORT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 VIRGINIA BYWAY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-4726
Mailing Address - Country:US
Mailing Address - Phone:727-510-4594
Mailing Address - Fax:
Practice Address - Street 1:155 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1950
Practice Address - Country:US
Practice Address - Phone:540-305-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177052363LP0808X
NC243311363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health