Provider Demographics
NPI:1558922971
Name:BETHEA, SHERRI FRANCIS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:FRANCIS
Last Name:BETHEA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-8111
Mailing Address - Country:US
Mailing Address - Phone:366-471-0137
Mailing Address - Fax:
Practice Address - Street 1:1289 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-8111
Practice Address - Country:US
Practice Address - Phone:366-471-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77266164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse