Provider Demographics
NPI:1386944502
Name:YARD, BETHANY ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ROSE
Last Name:YARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18601 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773
Mailing Address - Country:US
Mailing Address - Phone:715-538-4361
Mailing Address - Fax:715-538-2912
Practice Address - Street 1:18601 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773
Practice Address - Country:US
Practice Address - Phone:715-538-4361
Practice Address - Fax:715-538-2912
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2660-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical