Provider Demographics
NPI:1912215377
Name:MYERS, BETHANY ANN (PA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:541-278-4332
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:1140 SW SIMPSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3789
Practice Address - Country:US
Practice Address - Phone:541-388-2333
Practice Address - Fax:541-388-0930
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7756259-1206363AM0700X
ORPA196112363AS0400X
AK2251363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical