Bethany Dawn Jack

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

000083087 Issued in KY

Practice address

382 Bon Haven Rd
Maysville, KY 41056-9702

Phone

(606) 584-0518

NPI assigned

Mar 2, 2012

Last updated

Mar 2, 2012By 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": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330646400000",
    "number": "1336413764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 BON HAVEN RD",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 BON HAVEN RD",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569702",
            "telephone_number": "606-584-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "BETHANY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-02",
        "last_updated": "2012-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "KY",
            "license": "000083087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weylin Shamar Humphrey, CSA
• Ashley Hyatt, FNP-C
• Julie Ilhardt, LPCC, CADC
• Carol Inman
• Shannon Irish
• Jasmine Jackson
• James E Adams DMD Inc
• Barbara Kay Jefferson, PHD
• Jeffrey W Dickerson MD LLC
• Blake Jenkins, LDO

• Developmental Therapist in Maysville, KY
• Providers in Maysville, KY by specialty
• Developmental Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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.