# BETH PEMBROKE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1902304678
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 13987096-4405 | UT | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 271416 | AZ | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 79497 | NM | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | C-APN.0102379-C-NP | CO | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F405679-01 | NY | — |

## Other

- **Enumeration date:** 01/29/2018
- **Last updated:** 07/01/2025