Pamela Renee Bethel-Wilson, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

308544 Issued in NY

Practice address

4055 Valley View LN
Dallas, TX 75244-5074

Phone

(972) 715-3800

NPI assigned

Apr 13, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Mso LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1952196164

  Single Specialty

  Medicare reassignment NPD
• Hardy Renew Wellness,LLC

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1952914368

  Single Specialty

  Medicare reassignment NPD
• Medical Director Services PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Princess Anne, MD
  • NPI 1871955807

  GA, NY, Single Specialty

  Medicare reassignment NPD
• Patient First Medical Practice PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Brooklyn, NY
  • NPI 1255067955

  Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1013404292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 MAGNOLIA DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301346634",
            "telephone_number": "404-395-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445074",
            "telephone_number": "972-715-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHEL-WILSON",
        "first_name": "PAMELA",
        "middle_name": "RENEE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-13",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN181956",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "308544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yury Dianne Betancourt, OTR
• David Betancourth, M.D.
• Bethany Home Health of Lake Jackson LP
• Bethany Home Health of San Antonio, LP
• Bethel Medical Center, PLLC
• Eric Bethel
• Bethesda Assisted Living Center
• Bethesda Family Medical Clinic PLLC
• Bethesda Home Health Care, PLLC
• Bethesda Mental Health Consultants, PLLC

• Adult Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.