Bethel Universtiy

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

24365 Issued in TN

Legal business name

BETHEL UNIVERSTIY

Doing business as

Bethel Sports Medicine

Practice address

325 Cherry Ave
MC Kenzie, TN 38201-1769

Phone

(972) 367-4845

NPI assigned

Nov 15, 2017

Last updated

Dec 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristy Michelle Dunn

Title

Authorized Official

Phone

(731) 352-6428

Specialties & licenses 1

Addresses

Other names 1

• Bethel Sports Medicine Doing business as

Tax ID family

Bethel Sports Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bethel Universtiy

  • Student Health Clinic/Center
  • McKenzie, TN
  • NPI 1285914051
  NPD tax ID

Locations

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1508379322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 CHERRY AVE",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382011769",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL UNIVERSTIY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-15",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "731-352-6428"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "24365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Baker, NP-C
• Cloye Anita Barnhart-Gray, LCSW
• Madison Beaird, COTA
• Behavioral Health and Wellness
• Bethel Universtiy
• Trent Wade Borders, MD
• Botanical Emergency Physicians, LLC
• Meredith Ann Brown, NP-C, CHPN, MSN
• Thomas E Brown, MD
• Michael Lee Bryant, MD

• Family Medicine Physician in McKenzie, TN
• Providers in McKenzie, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.