Provider Demographics
NPI:1427091719
Name:AMOS, BETH ANNE (CRNA)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:AMOS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-8513
Mailing Address - Country:US
Mailing Address - Phone:304-848-0789
Mailing Address - Fax:
Practice Address - Street 1:103 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-8513
Practice Address - Country:US
Practice Address - Phone:304-848-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001706470OtherMSBSBS GROUP
WV0207026000Medicaid
WV27005299700OtherBRICKSTREET
WV270052997002OtherTRICARE
WV270052997003OtherTRICARE
WV001720951OtherBCBS
WV001720951OtherMSBCBS
WV0069168000Medicaid
WVP00253600OtherRR MEDICARE
WVDA0096OtherRR MEDICARE
WV1063502OtherBRICKSTREET
WV1063502OtherWORKER'S COMP.
WV270052997004OtherTRICARE GROUP
WV27005299700OtherWORKERS COMP
WV270052997003OtherTRICARE
WV8220713Medicare PIN