Provider Demographics
NPI:1184899296
Name:KRIEGER, BETHANY ANNE (CPNP)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANNE
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9073
Mailing Address - Country:US
Mailing Address - Phone:360-736-6778
Mailing Address - Fax:360-736-6552
Practice Address - Street 1:1911 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9073
Practice Address - Country:US
Practice Address - Phone:360-736-6778
Practice Address - Fax:360-736-6552
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2888363LP0200X
WAAP60086265363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200740904RNOtherRN LICENSE
WA60090952OtherRN LICENSURE
WA60091214OtherPNP LICENSE
AZAP2888OtherPNP LICENSE
TNRN0000157377OtherRN LICENSE
AZRN148694OtherRN LICENSE