Individual
MRS. BETHANY K FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, PMHNP-BC
Contact information
Practice address
815 S ASH ST, NEVADA, MO 64772-3222
(417) 667-8352
(417) 667-9216
Mailing address
328 DEER RUN DR, NEVADA, MO 64772-4303
(417) 321-4233
(417) 667-9216
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2017021753
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2019027475
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629599873
—
MO
Enumeration date
06/28/2017
Last updated
12/13/2024
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