Provider Demographics
NPI:1710546924
Name:BENNETT, KATHRYN ANESA (PNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANESA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANESA
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:22 RED JACKET STREET
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0491
Mailing Address - Country:US
Mailing Address - Phone:585-335-5200
Mailing Address - Fax:585-335-5037
Practice Address - Street 1:22 RED JACKET STREET
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-0491
Practice Address - Country:US
Practice Address - Phone:585-335-5200
Practice Address - Fax:585-335-5037
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382968208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics