Provider Demographics
NPI:1144262791
Name:JARVIS, BETHANY L (FNP)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:L
Last Name:JARVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0587
Mailing Address - Country:US
Mailing Address - Phone:207-509-3271
Mailing Address - Fax:207-509-3271
Practice Address - Street 1:248 STATE ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1850
Practice Address - Country:US
Practice Address - Phone:207-812-7031
Practice Address - Fax:207-660-4203
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81355363LF0000X
MERN28734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME248660099MedicaidMEDICAID - PERS
MENP278201Medicare PIN
P19975Medicare UPIN
MENP278202Medicare PIN
MEGRNP2782Medicare PIN