Provider Demographics
NPI:1518050491
Name:BENNETT, JENNIFER LEA (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LEA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:921 NE 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-270-0507
Mailing Address - Fax:
Practice Address - Street 1:921 NE 13TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-270-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily