Provider Demographics
NPI:1215233721
Name:HENDERSON, BETHANY ALISE (DNP)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ALISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ALISE
Other - Last Name:ORMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 CAVE SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4002
Mailing Address - Country:US
Mailing Address - Phone:575-621-1030
Mailing Address - Fax:
Practice Address - Street 1:1141 CAVE SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4002
Practice Address - Country:US
Practice Address - Phone:575-621-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily