Individual
MRS. AMBER D BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2604 SAINT MICHAEL DR STE 425, TEXARKANA, TX 75503-2378
(903) 614-5600
(903) 614-5630
Mailing address
2900 SAINT MICHAEL DR STE 401, TEXARKANA, TX 75503-5211
(903) 614-5393
(214) 614-5343
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C02148
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA8374
R/R MEDICARE GROUP #
MD
01
—
P00187315
R/R MEDICARE PROVIDER #
MD
Enumeration date
04/07/2006
Last updated
05/29/2019
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