Provider Demographics
NPI:1528619756
Name:MANNING, BETHANY DAWN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:DAWN
Last Name:MANNING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:DAWN
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:546 E SANDY LAKE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5786
Mailing Address - Country:US
Mailing Address - Phone:972-258-7426
Mailing Address - Fax:469-549-7818
Practice Address - Street 1:546 E SANDY LAKE RD STE 210
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5786
Practice Address - Country:US
Practice Address - Phone:972-258-7426
Practice Address - Fax:469-549-7818
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant