Provider Demographics
NPI:1629241385
Name:HUFFMAN, BETHANY JAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JAYNE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JAYNE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3620 CAPITAL AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-979-6200
Mailing Address - Fax:269-979-6201
Practice Address - Street 1:3620 CAPITAL AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9393
Practice Address - Country:US
Practice Address - Phone:269-979-6200
Practice Address - Fax:269-979-6201
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005223363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical