Provider Demographics
NPI:1770957441
Name:ISHMAEL, BETHANY JOY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:ISHMAEL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S HIGHWAY 78 STE 106
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3915
Mailing Address - Country:US
Mailing Address - Phone:972-801-9689
Mailing Address - Fax:
Practice Address - Street 1:303 S HIGHWAY 78 STE 106
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3915
Practice Address - Country:US
Practice Address - Phone:972-801-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129637363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics