Provider Demographics
NPI:1427816016
Name:STEPHENS, BETHANY D
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:D
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14325 EDINBURGH MOOR DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-6152
Mailing Address - Country:US
Mailing Address - Phone:813-846-5183
Mailing Address - Fax:
Practice Address - Street 1:14325 EDINBURGH MOOR DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6152
Practice Address - Country:US
Practice Address - Phone:813-846-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health