Provider Demographics
NPI:1386637155
Name:BENNETT, JUSTIN M (NP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:806 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5727
Mailing Address - Country:US
Mailing Address - Phone:337-365-4945
Mailing Address - Fax:337-376-6860
Practice Address - Street 1:567 WALKER ST
Practice Address - Street 2:
Practice Address - City:MERRYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70653-3040
Practice Address - Country:US
Practice Address - Phone:337-825-1728
Practice Address - Fax:337-825-1229
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2019-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477095Medicaid
LA4H429C822Medicare PIN
Q41370Medicare UPIN