Provider Demographics
NPI:1336486422
Name:BENNETT, COURTNEY ANITA (APMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ANITA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-4128
Mailing Address - Country:US
Mailing Address - Phone:601-581-7559
Mailing Address - Fax:
Practice Address - Street 1:1455 N LAKELAND DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-9020
Practice Address - Country:US
Practice Address - Phone:601-581-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02700224Medicaid
MS294918YS54Medicare PIN