Provider Demographics
NPI:1144534322
Name:WAYT, BETHANY LEIGH (RNC, CNM)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LEIGH
Last Name:WAYT
Suffix:
Gender:F
Credentials:RNC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 VESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1302
Mailing Address - Country:US
Mailing Address - Phone:937-399-7100
Mailing Address - Fax:
Practice Address - Street 1:1108 VESTER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1302
Practice Address - Country:US
Practice Address - Phone:937-399-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11370-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3088251Medicaid
OHNM041111OtherMEDICARE PTAN