Provider Demographics
NPI:1922504703
Name:BICK, BETHANY JOY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:BICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1889
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-1889
Mailing Address - Country:US
Mailing Address - Phone:503-805-5426
Mailing Address - Fax:
Practice Address - Street 1:193 FAIRVIEW LN STE B
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4828
Practice Address - Country:US
Practice Address - Phone:209-536-5100
Practice Address - Fax:209-588-0253
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA475415230OtherTAX ID