Provider Demographics
NPI:1376952895
Name:CONDRA, BETHANY ELAINE (NP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ELAINE
Last Name:CONDRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ELAINE
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DR STE E490
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1189
Mailing Address - Country:US
Mailing Address - Phone:423-531-6104
Mailing Address - Fax:423-531-6105
Practice Address - Street 1:725 GLENWOOD DR STE E490
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1189
Practice Address - Country:US
Practice Address - Phone:423-531-6104
Practice Address - Fax:423-531-6105
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily