Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0439245 | KS |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 16371 | NH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 241281 | MA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA08944200 | NJ |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD19366 | ME |
NPI | 1063621449 |
---|---|
Provider Name | Bethany J King |
First Address | Laconia, NH 03247-2010 |
Second Address | Wichita, KS 67205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 18/06/2018 |