Provider Demographics
NPI:1720437882
Name:BETHEL, DUSKA SUEDE DIXIE (DNP, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DUSKA
Middle Name:SUEDE DIXIE
Last Name:BETHEL
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:MISS
Other - First Name:DUSKA
Other - Middle Name:SUEDE DIXIE
Other - Last Name:HOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1062
Mailing Address - Country:US
Mailing Address - Phone:812-942-2300
Mailing Address - Fax:270-643-0082
Practice Address - Street 1:44 MCCOY AVE
Practice Address - Street 2:SUITE NUMBER 227
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2867
Practice Address - Country:US
Practice Address - Phone:270-825-0020
Practice Address - Fax:270-825-0016
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1119928163W00000X
KY3010243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK225560Medicare PIN
KYK225561Medicare PIN