Provider Demographics
NPI:1316393242
Name:PIGMAN, BETHANY LEE (RD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEE
Last Name:PIGMAN
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:LEE
Other - Last Name:TACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:283 GOBLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7967
Mailing Address - Country:US
Mailing Address - Phone:606-886-2788
Mailing Address - Fax:606-886-7989
Practice Address - Street 1:283 GOBLE ST
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7967
Practice Address - Country:US
Practice Address - Phone:606-886-2788
Practice Address - Fax:606-886-7989
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86009317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20036018Medicaid