1609959196 NPI number — MS. BETHANY LYNNE CHAPPELL DPT

Table of content: (NPI 1326831488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609959196 NPI number — MS. BETHANY LYNNE CHAPPELL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPPELL
Provider First Name:
BETHANY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609959196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 SW 68TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505-9020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-583-2300
Provider Business Mailing Address Fax Number:
580-458-2908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 MOW-WAY ROAD
Provider Second Line Business Practice Location Address:
REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: MS PRESCOTT)
Provider Business Practice Location Address City Name:
FORT SILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-458-2134
Provider Business Practice Location Address Fax Number:
580-458-2314
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTL.0010200 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)