Provider Demographics
NPI:1457827040
Name:BENNETT, PAMELA DIANA (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MILK PEA RD
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9326
Mailing Address - Country:US
Mailing Address - Phone:910-986-6397
Mailing Address - Fax:
Practice Address - Street 1:334 MILL CREEK RD STE D
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-6525
Practice Address - Country:US
Practice Address - Phone:910-725-0809
Practice Address - Fax:910-725-2018
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily