Provider Demographics
NPI:1407626658
Name:BENNETT, NICOLE RHEA (PMHNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RHEA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E. DANIELDALE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137
Mailing Address - Country:US
Mailing Address - Phone:469-868-6250
Mailing Address - Fax:
Practice Address - Street 1:102 E. DANIELDALE RD
Practice Address - Street 2:STE 101
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137
Practice Address - Country:US
Practice Address - Phone:469-868-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142332363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health