Provider Demographics
NPI:1821192063
Name:DESCHAMPS, BETHANY A (RD)
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:A
Last Name:DESCHAMPS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:BETHANY
Other - Middle Name:A
Other - Last Name:BELANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9040 JACKSON AVENUE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1110
Mailing Address - Country:US
Mailing Address - Phone:785-239-8612
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-1110
Practice Address - Country:US
Practice Address - Phone:785-239-8612
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06619133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered