Provider Demographics
NPI:1891235883
Name:BENNETT, SIERRA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:REPASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1141
Mailing Address - Country:US
Mailing Address - Phone:304-329-1400
Mailing Address - Fax:304-329-1175
Practice Address - Street 1:12302 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547
Practice Address - Country:US
Practice Address - Phone:304-980-2006
Practice Address - Fax:304-980-2008
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV81130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner