Provider Demographics
NPI:1740935220
Name:BEATY, BETHANY ANNE (HIS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:BEATY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:110 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5432
Mailing Address - Country:US
Mailing Address - Phone:256-489-1236
Mailing Address - Fax:
Practice Address - Street 1:2030 CECIL ASHBURN DR SE STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2578
Practice Address - Country:US
Practice Address - Phone:256-489-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2331237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist