Provider Demographics
NPI:1255792792
Name:SMITH, BETHANY MELVA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:MELVA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-654-6213
Mailing Address - Fax:740-654-3346
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-654-6213
Practice Address - Fax:740-654-3346
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004520RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant