Provider Demographics
NPI:1558922351
Name:BOND, BETHANY KAY (RDN, LD, IBCLC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:BOND
Suffix:
Gender:F
Credentials:RDN, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 HART LN APT 2048
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2413
Mailing Address - Country:US
Mailing Address - Phone:817-559-1167
Mailing Address - Fax:
Practice Address - Street 1:7201 HART LN APT 2048
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2413
Practice Address - Country:US
Practice Address - Phone:817-559-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1054605133V00000X
L-157456174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN