Provider Demographics
NPI:1922619535
Name:ATKINS, HANNAH BETHANY (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:BETHANY
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 GERIG DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6343
Mailing Address - Country:US
Mailing Address - Phone:309-533-7070
Mailing Address - Fax:855-710-6552
Practice Address - Street 1:3302 GERIG DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6343
Practice Address - Country:US
Practice Address - Phone:309-533-7070
Practice Address - Fax:855-710-6552
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
ALPA2022363A00000X
FLPA9116124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300058643Medicaid
KYK401990OtherKY MEDICARE