Individual
JORDYN DEBORAH BETHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3001 S HANOVER ST STE 216A, BALTIMORE, MD 21225-1233
(410) 350-2106
Mailing address
414 LIGHT ST UNIT 4201, BALTIMORE, MD 21202-1347
(732) 310-8214
(561) 498-0320
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0007175
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018266800
—
FL
Enumeration date
06/25/2013
Last updated
10/10/2019
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