Provider Demographics
NPI:1497299317
Name:BENNETT, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N HIGHWAY 10
Mailing Address - Street 2:1200 N HIGHWAY 10
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435-5148
Mailing Address - Country:US
Mailing Address - Phone:918-489-5587
Mailing Address - Fax:
Practice Address - Street 1:1200 N HIGHWAY 10
Practice Address - Street 2:1200 N HIGHWAY 10
Practice Address - City:GORE
Practice Address - State:OK
Practice Address - Zip Code:74435-5148
Practice Address - Country:US
Practice Address - Phone:918-489-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant