Provider Demographics
NPI:1790237949
Name:VOLKART, BETHANY RENEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:RENEE
Last Name:VOLKART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:RENEE
Other - Last Name:POHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:1233 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2409
Practice Address - Country:US
Practice Address - Phone:734-467-0005
Practice Address - Fax:734-451-0005
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016034328363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790237949Medicaid