Provider Demographics
NPI:1275970725
Name:BENNETT, SONDRA MICHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:MICHELLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S THOMAS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5337
Mailing Address - Country:US
Mailing Address - Phone:662-205-6905
Mailing Address - Fax:662-269-6722
Practice Address - Street 1:2434 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-6416
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859958363LP0808X
MSR859958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health