Provider Demographics
NPI:1710137583
Name:BENNETT, JOHN KELLY (RT (R,CT))
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KELLY
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RT (R,CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 KINSMERE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4528
Mailing Address - Country:US
Mailing Address - Phone:727-236-5309
Mailing Address - Fax:
Practice Address - Street 1:1661 KINSMERE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4528
Practice Address - Country:US
Practice Address - Phone:727-236-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT529012471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography