Provider Demographics
NPI:1568745214
Name:BENNINGFIELD, LAURA CHINN
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CHINN
Last Name:BENNINGFIELD
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 1:1779 KENILWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4778
Mailing Address - Country:US
Mailing Address - Phone:270-875-2882
Mailing Address - Fax:
Practice Address - Street 1:1145 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2419
Practice Address - Country:US
Practice Address - Phone:270-842-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist