Provider Demographics
NPI:1396477576
Name:HEINRICH, BETHANY MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6153 RADIANT SKY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2093
Mailing Address - Country:US
Mailing Address - Phone:719-243-9802
Mailing Address - Fax:
Practice Address - Street 1:3910 S CAREFREE CIR STE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3053
Practice Address - Country:US
Practice Address - Phone:719-635-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1625448163W00000X
COAPN.00998715-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse