Provider Demographics
NPI:1558059170
Name:ANDERSEN, BETHANY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 COLBY RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4180
Mailing Address - Country:US
Mailing Address - Phone:912-230-7158
Mailing Address - Fax:
Practice Address - Street 1:720 COOL SPRINGS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7259
Practice Address - Country:US
Practice Address - Phone:615-709-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN243594163WP0808X
TN2022140013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health