Provider Demographics
NPI:1760107049
Name:BETHEL, JAMIE YVONNE (NP)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:YVONNE
Last Name:BETHEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1943
Mailing Address - Country:US
Mailing Address - Phone:803-216-4408
Mailing Address - Fax:
Practice Address - Street 1:1403 GREENBRIER MOSSYDALE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-8932
Practice Address - Country:US
Practice Address - Phone:803-216-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30089363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health