Provider Demographics
NPI:1942258272
Name:BETHUNE, ANGELA DAWN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 COUNTY RD 155
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:AL
Mailing Address - Zip Code:35966-9127
Mailing Address - Country:US
Mailing Address - Phone:352-636-4193
Mailing Address - Fax:
Practice Address - Street 1:508 COUNTY ROAD 155
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:AL
Practice Address - Zip Code:35966-9127
Practice Address - Country:US
Practice Address - Phone:352-636-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1742912363LP2300X
NC5013540363LF0000X
AL1-185052363LF0000X
GAGAA-NP000485363LF0000X
TN30628363LF0000X
MARN268922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ081665Medicaid
FL593736126OtherAETNA
FL82127OtherBCBS
FL300864900Medicaid
S55600Medicare UPIN