Provider Demographics
NPI:1992470710
Name:HARTER, BETHANY JOY (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:HARTER
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-131 WAIKALUA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2750
Mailing Address - Country:US
Mailing Address - Phone:910-286-8338
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL
Practice Address - Street 2:1 JARRET WHITE ROAD /CAFBHS
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-67616163WP0807X, 163WP0808X, 163WC0400X
HIAPRN-1267171000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171000000XOther Service ProvidersMilitary Health Care Provider
No163WC0400XNursing Service ProvidersRegistered NurseCase Management