Provider Demographics
NPI:1982239463
Name:BETHEA, ASHLEY A (CPC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:A
Last Name:BETHEA
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 SPINEL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6862
Mailing Address - Country:US
Mailing Address - Phone:910-709-3810
Mailing Address - Fax:
Practice Address - Street 1:4422 SPINEL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6862
Practice Address - Country:US
Practice Address - Phone:910-709-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC50385637Medicaid