Provider Demographics
NPI:1205642543
Name:ABBOTT, BETHANY R
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:R
Last Name:ABBOTT
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 1:9 BLACKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8913
Mailing Address - Country:US
Mailing Address - Phone:501-672-9911
Mailing Address - Fax:
Practice Address - Street 1:9 BLACKBERRY RD
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8913
Practice Address - Country:US
Practice Address - Phone:501-672-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator