Provider Demographics
NPI:1164650420
Name:BENNETT, KAREN WEBB (PHD, RD, MSN, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:WEBB
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD, RD, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6760
Mailing Address - Country:US
Mailing Address - Phone:336-633-7000
Mailing Address - Fax:336-625-3817
Practice Address - Street 1:110 W WALKER AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6760
Practice Address - Country:US
Practice Address - Phone:336-633-7000
Practice Address - Fax:336-625-3817
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950062NP363LP0808X
NC191449363LP0808X
AK1323363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health