Provider Demographics
NPI:1700828688
Name:BENNETT, KARA ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:MOFFATT
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:306 W 11TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1746
Mailing Address - Country:US
Mailing Address - Phone:814-240-6216
Mailing Address - Fax:814-240-2619
Practice Address - Street 1:306 W 11TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1746
Practice Address - Country:US
Practice Address - Phone:814-240-6216
Practice Address - Fax:814-240-2619
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005762B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q15188Medicare UPIN
PA078785ZNPBMedicare PIN