Individual
BETHANY RENEE' THACKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
108 SMITH ST, PORTSMOUTH, OH 45662-8766
(740) 250-4630
Mailing address
108 SMITH ST, PORTSMOUTH, OH 45662-8766
(740) 250-4630
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.367136
OH
Other
Enumeration date
09/12/2020
Last updated
09/12/2020
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