Provider Demographics
NPI:1467894089
Name:BENNETT, NATHAN KYLE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:KYLE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BROWN HILL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FRAKES
Mailing Address - State:KY
Mailing Address - Zip Code:40940-9523
Mailing Address - Country:US
Mailing Address - Phone:606-337-1832
Mailing Address - Fax:
Practice Address - Street 1:349 BOGLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2895
Practice Address - Country:US
Practice Address - Phone:606-451-9448
Practice Address - Fax:606-451-9540
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1804363A00000X, 363AM0700X
KYTC208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant