License Verification

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BETHANY SMITH

License Number: PA9109967

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9109967
License Status
DELINQUENT/
Qualifications
Prescribing
License Expiration Date
1/31/2024
License Original Issue Date
10/14/2016
Address of Record
1075 Mason Ave
DAYTONA BEACH, FL 32117
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1890 LPGA Blvd, Suite 240
DAYTONA BEACH, FL 32117
Address
17 Old Kings Rd N, Suite K
PALM COAST, FL 32137
Address
1165 Dunlawton Ave, Suite 102
PORT ORANGE, FL 32127
Address
1175 Dunlawton Ave, Suite 1
PORT ORANGE, FL 32127
Name Relationship Profession License Effective Date
BRYAN, JAMES MCMASTER Supervising Prescribing Practitioner Medical Doctor 71007 01/31/2019
GAINES, RICHARD KENNETH MD Supervising Prescribing Practitioner Medical Doctor 60285 01/31/2019
GILLESPY, ALBERT WILLIAM Supervising Prescribing Practitioner Medical Doctor 50714 01/31/2019
GILLESPY, MARK CABOT M D Supervising Prescribing Practitioner Medical Doctor 52207 01/31/2019
HATTEN, BRIAN RUSSELL Supervising Prescribing Practitioner Medical Doctor 88918 01/31/2019
LAMBIE, BRITTNEY LEWIS Supervising Prescribing Practitioner Medical Doctor 132535 01/31/2019
MARTIN, JEFFREY WILLIAM Supervising Prescribing Practitioner Medical Doctor 83250 01/31/2019
MATTHEWS, CHRISTOPHER JOHN Supervising Prescribing Practitioner Medical Doctor 130656 01/31/2019
MCCALL, TODD ANDREW Supervising Prescribing Practitioner Medical Doctor 91561 01/31/2019

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/23/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


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