Individual provider Active NPI

Dawn Louise Bethea, ARNP

  • Family Nurse Practitioner
  • Chesapeake, VA
National Provider Identifier
1346542800
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024174788 Issued in VA
Practice address
300 Medical Pkwy Ste 110
Chesapeake, VA 23320-4985
Phone
(757) 623-0005
Fax
(757) 410-7349
NPI assigned
Dec 3, 2010
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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 0024174788 VA Primary

Addresses

Primary practice location

300 Medical Pkwy Ste 110
Chesapeake, VA 23320-4985

Mailing address

4445 Corporation LN Ste 100
Virginia Beach, VA 23462-3666
Phone (757) 623-0005

Other identifiers 1

IdentifierTypeStateIssuer
VVR2995AOtherVAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180328001735 VA Practitioner - Nurse Practitioner 5597027789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Kidney Specialists IncGroup PAC ID 6507852662, 21 clinicians

Practice addresses (Care Compare)

814 Kempsville Rd
Suite 102
Norfolk, VA 23502-4001
Phone (757) 623-0005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024174788VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Kidney Specialists, Inc. CurrentSince Jan 20, 2018 Accepting new patients
Tidewater Kidney Specialists, Inc. CurrentSince Jan 20, 2018 Accepting new patients

Locations

300 Medical Pkwy
Ste 110
Chesapeake, VA 23320
Phone (757) 436-1005

301 Riverview Ave
Ste 512
Norfolk, VA 23510
Phone (757) 627-5116

814 Kempsville Rd
Ste 102
Norfolk, VA 23502

4445 Corporation Ln
Ste 100
Virginia Beach, VA 23462

4560 South Blvd
Ste 202
Virginia Beach, VA 23452
Phone (757) 340-6100

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1291334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1346542800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623666",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEDICAL PKWY STE 110",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204985",
            "telephone_number": "757-623-0005",
            "fax_number": "757-410-7349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHEA",
        "first_name": "DAWN",
        "middle_name": "LOUISE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-03",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024174788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "VVR2995A",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.