Bethany Grace Druvenga, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126001802 Issued in VA

Practice address

1301 College Ave # 103
Fredericksburg, VA 22401-5300

Phone

(540) 654-1874

NPI assigned

Feb 26, 2014

Last updated

Aug 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1245655398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 HUDGINS FARM CIR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224084191",
            "telephone_number": "712-260-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 COLLEGE AVE # 103",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015300",
            "telephone_number": "540-654-1874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235048050",
            "country_code": "US",
            "telephone_number": "757-823-9547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRUVENGA",
        "first_name": "BETHANY",
        "middle_name": "GRACE",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-26",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126001802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.