Provider Demographics
NPI:1285241166
Name:ROSE, BETHANY MICHELLE (RD, CSR, LD)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:MICHELLE
Last Name:ROSE
Suffix:
Gender:
Credentials:RD, CSR, LD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2529 VALAIS CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-5408
Mailing Address - Country:US
Mailing Address - Phone:270-723-2930
Mailing Address - Fax:
Practice Address - Street 1:5721 BIGGER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-2752
Practice Address - Country:US
Practice Address - Phone:270-723-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264496133V00000X
OHLD.10377133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered