Provider Demographics
NPI:1780931154
Name:CARSON, BETHANNE FONDREN (PMHNP)
Entity type:Individual
Prefix:
First Name:BETHANNE
Middle Name:FONDREN
Last Name:CARSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DR MICHAEL DEBAKEY DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5864
Mailing Address - Country:US
Mailing Address - Phone:337-478-9828
Mailing Address - Fax:409-899-9795
Practice Address - Street 1:333 DOCTOR MICHAEL DEBAKEY DR STE 220
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5888
Practice Address - Country:US
Practice Address - Phone:337-478-9331
Practice Address - Fax:337-478-9828
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122153363LP0808X
LAAP09425363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health