Provider Demographics
NPI:1598061442
Name:COMMONS, BETHANY M (CRNA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:COMMONS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:M
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120006367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220754004Medicaid
TX8251UHOtherBCBS
TXP01445982OtherRAILROAD
TX339967YK6UMedicare PIN
TX220754001Medicaid
TXTXB123897Medicare PIN
TXTXB127077Medicare PIN