Provider Demographics
NPI:1548823966
Name:FOSS, BETHANY JEANETTE
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JEANETTE
Last Name:FOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213B W MASON ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1262
Mailing Address - Country:US
Mailing Address - Phone:816-339-5526
Mailing Address - Fax:816-207-0558
Practice Address - Street 1:213B W MASON ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1262
Practice Address - Country:US
Practice Address - Phone:816-339-5526
Practice Address - Fax:816-207-0558
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner