Provider Demographics
NPI:1891367165
Name:BETHEA, TIFFANY YVONNE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:YVONNE
Last Name:BETHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:YVONNE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 WEATHERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7579
Mailing Address - Country:US
Mailing Address - Phone:757-944-7704
Mailing Address - Fax:757-224-1561
Practice Address - Street 1:252 WEATHERFORD WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7579
Practice Address - Country:US
Practice Address - Phone:757-944-7704
Practice Address - Fax:757-224-1561
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT61755910343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)