Provider Demographics
NPI:1679041743
Name:CARTER, BETHANY MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:CARTER
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:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-0611
Mailing Address - Country:US
Mailing Address - Phone:209-470-5040
Mailing Address - Fax:
Practice Address - Street 1:299 12TH ST
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6003
Practice Address - Country:US
Practice Address - Phone:831-647-7652
Practice Address - Fax:831-647-7940
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014589363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health