Provider Demographics
NPI:1871209239
Name:PERKINS, BETHANY J (FNP-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:PERKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:WENTZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 LONGFELLOW LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1717
Mailing Address - Country:US
Mailing Address - Phone:361-652-3122
Mailing Address - Fax:
Practice Address - Street 1:506 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6060
Practice Address - Country:US
Practice Address - Phone:361-788-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1109149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty