Provider Demographics
NPI:1023404043
Name:PICKARD, BETHANY LAKAY (MD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:LAKAY
Last Name:PICKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:LAKAY
Other - Last Name:ALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:79095-3703
Mailing Address - Country:US
Mailing Address - Phone:806-447-2521
Mailing Address - Fax:
Practice Address - Street 1:1011 15TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:TX
Practice Address - Zip Code:79095-3703
Practice Address - Country:US
Practice Address - Phone:806-447-5311
Practice Address - Fax:806-447-3090
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10054171390200000X
390200000X
TXR7568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program