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Individual
BETHANY R SHANKU
Active
Individual
BETHANY R SHANKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0796
NH
363A00000X
Physician Assistant
Primary
5601007853
MI
363AM0700X
Medical Physician Assistant
015254
NY
363AM0700X
Medical Physician Assistant
PA1507
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3665093
—
TN
01
—
4158075
BC/BS TN - CUMBERLAND BACK PAIN CLINIC, P.C.
TN
01
—
4190395
BS/BS TN - LEBANON BACK PAIN CLINIC, P.C.
TN
01
—
PA1507
STATE LICENSE
TN
Enumeration date
07/30/2007
Last updated
04/15/2026
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