Provider Demographics
NPI:1801331152
Name:STERN, BETHANY M (FNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:STERN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:M
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 419052
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9052
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4449
Practice Address - Street 1:637 DUNN RD STE 170
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1759
Practice Address - Country:US
Practice Address - Phone:314-838-5702
Practice Address - Fax:314-839-5596
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016038521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily