Provider Demographics
NPI:1790499515
Name:BENNETT, ASHLEY AMBER (PMHNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:AMBER
Other - Last Name:MCKEITHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11330 LEGACY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1210
Mailing Address - Country:US
Mailing Address - Phone:469-215-5913
Mailing Address - Fax:469-777-4542
Practice Address - Street 1:11330 LEGACY DR STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1210
Practice Address - Country:US
Practice Address - Phone:469-215-5913
Practice Address - Fax:469-777-4542
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097764363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health