Provider Demographics
NPI:1821067083
Name:BETHI, KRISHNAVENI (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAVENI
Middle Name:
Last Name:BETHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HOSPITAL PARKWAY, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-848-2880
Mailing Address - Fax:817-848-2890
Practice Address - Street 1:1604 HOSPITAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5913
Practice Address - Country:US
Practice Address - Phone:817-848-2880
Practice Address - Fax:817-848-2890
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15226R207R00000X
TXQ7146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4F646Medicare PIN
H99171Medicare UPIN