| Doctor Name: | BETHANY KATE AUGUSTINE |
| NPI Number: | 1104228568 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | C05554 |
| Business Practice Address: | 5401 Old Court Rd Randallstown, MD - 211335103 |
| Business Phone Number: | 4105212200 |
| Business Fax Number: | |
| Mailing Address: | 4380 Doncaster Dr, ELLICOTT CITY |
| State: | MD |
| Postal Code: | 210436782 |
| Phone Number: | 4432207546 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2014 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C05554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |