Provider Demographics
NPI:1467730127
Name:BENNETT, REBEKAH J (CRNA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1651 GUNBARREL RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3289
Practice Address - Country:US
Practice Address - Phone:423-308-0390
Practice Address - Fax:423-308-0393
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15951367500000X
TNRN159474367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525881Medicaid
GA003113481AMedicaid
GA003113481CMedicaid
4306850OtherBCBS OF TN
GA003113181BMedicaid
GA003113481DMedicaid
P00983456OtherRAILROAD MEDICARE
GA003113181BMedicaid