Provider Demographics
NPI:1215282132
Name:ROLLINS, BETHANY CAROLEE (MS, APRN, NP-C, FNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:CAROLEE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:MS, APRN, NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:103 E WILLIAMS RD
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-1109
Mailing Address - Country:US
Mailing Address - Phone:405-547-6222
Mailing Address - Fax:405-547-6223
Practice Address - Street 1:103 E WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-5917
Practice Address - Country:US
Practice Address - Phone:405-547-6222
Practice Address - Fax:405-547-6223
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK71772OtherAPRN, CNP, RX, OK STATE LICENSE
OK200443880AMedicaid
OK200443880AMedicaid