Provider Demographics
NPI:1790300317
Name:DEMMITT, BETHANIE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BETHANIE
Middle Name:
Last Name:DEMMITT
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E MISSOURI AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2736
Mailing Address - Country:US
Mailing Address - Phone:602-283-4711
Mailing Address - Fax:602-671-4260
Practice Address - Street 1:1130 E MISSOURI AVE STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2736
Practice Address - Country:US
Practice Address - Phone:602-283-4711
Practice Address - Fax:602-671-4260
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily