Provider Demographics
NPI:1619517414
Name:HORN, BETHANY LOUISE (PA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LOUISE
Last Name:HORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:LOUISE
Other - Last Name:ZABLOTSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 CAPITAL MALL DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:607-066-2093
Practice Address - Fax:360-704-4751
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5934363AM0700X
CO6139363AM0700X
WAPA61563479363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical