Provider Demographics
NPI:1922125327
Name:BENNETT, ALLISON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-3126
Mailing Address - Country:US
Mailing Address - Phone:580-625-2273
Mailing Address - Fax:580-625-2274
Practice Address - Street 1:623 AVENUE C
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3126
Practice Address - Country:US
Practice Address - Phone:580-625-2273
Practice Address - Fax:580-625-2274
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO71654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000161899OtherBCBS KS