Provider Demographics
NPI:1982357463
Name:FLANNIGAN, BETHANY (CNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:FLANNIGAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 SEVEN LAKES PL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7866
Mailing Address - Country:US
Mailing Address - Phone:740-816-5532
Mailing Address - Fax:
Practice Address - Street 1:9520 W PALM LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4403
Practice Address - Country:US
Practice Address - Phone:623-388-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028184363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics