Provider Demographics
NPI:1205103512
Name:PARKER, BETHANY CORINNE (MSNA)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:CORINNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SEA OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-5841
Mailing Address - Country:US
Mailing Address - Phone:307-679-9151
Mailing Address - Fax:
Practice Address - Street 1:3017 13TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1833
Practice Address - Country:US
Practice Address - Phone:228-831-0050
Practice Address - Fax:228-831-1121
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17714367500000X
MS810640367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered