Provider Demographics
NPI:1841791670
Name:KATELY BENNETT, SHARNELL RENEE
Entity Type:Individual
Prefix:
First Name:SHARNELL
Middle Name:RENEE
Last Name:KATELY BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3321
Mailing Address - Country:US
Mailing Address - Phone:337-326-8837
Mailing Address - Fax:
Practice Address - Street 1:8325 HUDSON RD
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-3321
Practice Address - Country:US
Practice Address - Phone:337-326-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009584739343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)