Provider Demographics
NPI:1306658463
Name:DOUGLAS, BETHANY LAURIAN (MSN FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LAURIAN
Last Name:DOUGLAS
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Gender:F
Credentials:MSN FNP-C
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Mailing Address - Street 1:320 W MOUNT VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1940
Mailing Address - Country:US
Mailing Address - Phone:417-461-0056
Mailing Address - Fax:
Practice Address - Street 1:320 W MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1940
Practice Address - Country:US
Practice Address - Phone:417-461-0056
Practice Address - Fax:833-707-1944
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2025001784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily