Provider Demographics
NPI:1093368433
Name:BENNETT, JESSICA SOPHIA (BSN, SRNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOPHIA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BSN, SRNA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SOPHIA
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 HERITAGE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8492
Mailing Address - Country:US
Mailing Address - Phone:919-606-8289
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270909367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered