Bethany Amanda Peterson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN213705 Issued in GA

Practice address

6228 Bradley Park Dr Ste a
Columbus, GA 31904-3605

Phone

(706) 322-1486

Fax

(706) 324-3419

NPI assigned

Oct 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, AL2 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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Renal Associates of Lagrange LLCGroup PAC ID 3678712312, 12 clinicians

Renal Associates, LLCGroup PAC ID 7911891403, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar West Georgia Medical Center Hospital, Lagrange, GA, CCN 110016
• St Francis Hospital- Emory Healthcare Hospital, Columbus, GA, CCN 110129

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bethany.peterson@direct.davitaphysiciansolutions.com

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.

• Renal Associates of Lagrange LLC

  • Nephrology Physician
  • Lagrange, GA
  • NPI 1679813406
  Medicare reassignment Care Compare group NPD
• Renal Associates, LLC

  • Nephrology Physician
  • Columbus, GA
  • NPI 1205944311

  AL

  Medicare reassignment Care Compare group NPD
• Renal Associates of Alabama, LLC

  • Nephrology Physician
  • Montgomery, AL
  • NPI 1447742168

  Family

  Medicare reassignment NPD
• Renal Associates of Roanoke, LLC

  • Nephrology Physician
  • Roanoke, AL
  • NPI 1447017314
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Francis Health LLC

  • General Acute Care Hospital
  • Columbus, GA
  • NPI 1033228168
  Care Compare affiliation
• West Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Lagrange, GA
  • NPI 1821221144
  Care Compare affiliation

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1144827957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776",
            "city": "CATAULA",
            "state": "GA",
            "postal_code": "318040776",
            "telephone_number": "706-570-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6228 BRADLEY PARK DR STE A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043605",
            "telephone_number": "706-322-1486",
            "fax_number": "706-324-3419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1216 Stark Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319062500",
            "country_code": "US",
            "telephone_number": "706-320-0801",
            "fax_number": "706-324-3419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3368 Highway 280 Ste 120",
            "address_purpose": "LOCATION",
            "city": "Alexander City",
            "state": "AL",
            "postal_code": "350103375",
            "country_code": "US",
            "telephone_number": "256-392-5282",
            "fax_number": "706-324-3419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42 Mitylene Park Ln",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361177306",
            "country_code": "US",
            "telephone_number": "334-603-6626",
            "fax_number": "334-239-7808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BETHANY",
        "middle_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-05",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-130643",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN213705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://dva-portal.et1087.epichosted.com/vpn/index.html",
            "affiliation": "N",
            "endpointDescription": "EPIC CKD EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6228 Bradley Park Dr Ste A",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319043605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Personal Medication Consulting, P.C.
• Dainisecia Pessoa, RN
• Mark Peters, APRN
• Melissa Brooke Peters
• Pearlie Peterson-Cornett, D.O.
• Denice Peterson
• Dixie Peterson, NP-C
• Felicia Peterson
• Heather Payton Melissa Peterson, SLP
• Jasmine Peterson, PA

• Family Nurse Practitioner in Columbus, GA
• Providers in Columbus, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.