Provider Demographics
NPI:1770075764
Name:BIA, BETHANY S (APRN-FNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:S
Last Name:BIA
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:S
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0179
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:212 W SPAULDING ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2452
Practice Address - Country:US
Practice Address - Phone:918-967-3368
Practice Address - Fax:918-967-4582
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109224363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care