Individual
MR. KENNETH SCOTT BETHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, FNP
Contact information
Practice address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-7635
Mailing address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-7635
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28138800A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003875A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201043130
—
IN
Enumeration date
12/08/2011
Last updated
11/03/2023
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