Provider Demographics
NPI:1780201996
Name:DAVIDSON, BETHANY (LVN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22227 FM 16 W
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5402
Mailing Address - Country:US
Mailing Address - Phone:903-714-0888
Mailing Address - Fax:
Practice Address - Street 1:22227 FM 16 W
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5402
Practice Address - Country:US
Practice Address - Phone:903-714-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344923164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse