Provider Demographics
NPI:1639148190
Name:MCCLEAN, BETHANY (RN, CFNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E ARBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3240
Mailing Address - Country:US
Mailing Address - Phone:682-867-1500
Mailing Address - Fax:817-419-1129
Practice Address - Street 1:1501 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-2263
Practice Address - Country:US
Practice Address - Phone:817-920-6600
Practice Address - Fax:817-920-6632
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252859363LF0000X
TXAP104951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091872404Medicaid
TX091872404Medicaid
TX8D9183Medicare ID - Type Unspecified