Provider Demographics
NPI:1962838607
Name:KANE, BETHANY ELYSE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:ELYSE
Last Name:KANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:26840 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1409
Mailing Address - Country:US
Mailing Address - Phone:301-475-8091
Mailing Address - Fax:301-475-6712
Practice Address - Street 1:296 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4648
Practice Address - Country:US
Practice Address - Phone:717-812-5050
Practice Address - Fax:717-741-2427
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA064217363LF0000X
MDC0005150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical