Provider Demographics
NPI:1821570482
Name:TENNYSON, BETHANY ANN (MS,MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANN
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:MS,MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 E LOCUST PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2642
Mailing Address - Country:US
Mailing Address - Phone:480-313-1770
Mailing Address - Fax:
Practice Address - Street 1:875 S DOBSON RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5720
Practice Address - Country:US
Practice Address - Phone:480-899-9800
Practice Address - Fax:480-899-9800
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant