Individual provider Active NPI

Bethany Ann Stough, CRNP

  • Family Nurse Practitioner
  • State College, PA
National Provider Identifier
1154814002
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP018921 Issued in PA
Practice address
320 Rolling Ridge Dr Ste 203
State College, PA 16801-7641
Phone
(814) 208-9868
Fax
(833) 525-1877
NPI assigned
Jun 14, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP018921 PA Primary

Addresses

Primary practice location

320 Rolling Ridge Dr Ste 203
State College, PA 16801-7641

Mailing address

320 Rolling Ridge Dr Ste 203
State College, PA 16801-7641
Phone (814) 208-9868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Jan 1, 2026 through Jan 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP018921PAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1154814002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 ROLLING RIDGE DR STE 203",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017641",
            "telephone_number": "814-208-9868",
            "fax_number": "833-525-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 ROLLING RIDGE DR STE 203",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017641",
            "telephone_number": "814-208-9868",
            "fax_number": "833-525-1877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUGH",
        "first_name": "BETHANY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-14",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP018921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.