Provider Demographics
NPI:1043861735
Name:BENNETT, SARA (APRN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3452
Mailing Address - Country:US
Mailing Address - Phone:812-280-2080
Mailing Address - Fax:
Practice Address - Street 1:101 NOAHS LN BLDG 215
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5380
Practice Address - Country:US
Practice Address - Phone:812-284-1760
Practice Address - Fax:812-282-4316
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009407A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health