Provider Demographics
NPI:1396451936
Name:BETHLEY, EUNICE (MPA)
Entity type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:
Last Name:BETHLEY
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 INDUSTRIPLEX BLVD # AA267
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3921
Mailing Address - Country:US
Mailing Address - Phone:225-281-3058
Mailing Address - Fax:
Practice Address - Street 1:263 CONCORDIA DR
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2969
Practice Address - Country:US
Practice Address - Phone:225-281-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)