Provider Demographics
NPI:1629377015
Name:ENGEL, BETHANY KRISTEN (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:KRISTEN
Last Name:ENGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:KRISTEN
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:151 JOHN BRADY DR
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8401
Practice Address - Country:US
Practice Address - Phone:570-935-0468
Practice Address - Fax:570-935-0479
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031574440001Medicaid