Provider Demographics
NPI:1700981883
Name:RATLIFF, BETHANY RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:RUTH
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:RUTH
Other - Last Name:ULDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:617 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1137
Mailing Address - Country:US
Mailing Address - Phone:304-364-8941
Mailing Address - Fax:304-364-8943
Practice Address - Street 1:617 RIVER ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1137
Practice Address - Country:US
Practice Address - Phone:304-364-8941
Practice Address - Fax:304-364-8943
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012243Medicaid
WV2031755Medicare PIN
WV2031756Medicare PIN
WV2031751Medicare PIN
WV3810012243Medicaid
WV2031752Medicare PIN
WV2031754Medicare PIN