Provider Demographics
NPI:1689008823
Name:BENNETT, THERESE C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1925
Mailing Address - Country:US
Mailing Address - Phone:270-885-5003
Mailing Address - Fax:270-885-5826
Practice Address - Street 1:1721 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1925
Practice Address - Country:US
Practice Address - Phone:270-885-5003
Practice Address - Fax:270-885-5826
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily