Provider Demographics
NPI:1841069374
Name:KONTAXES, BETHANY (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KONTAXES
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 HENDERSHOT RD
Mailing Address - Street 2:
Mailing Address - City:KENNERDELL
Mailing Address - State:PA
Mailing Address - Zip Code:16374-5824
Mailing Address - Country:US
Mailing Address - Phone:814-720-6445
Mailing Address - Fax:
Practice Address - Street 1:1047 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2670
Practice Address - Country:US
Practice Address - Phone:814-346-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008306133NN1002X, 133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered