Provider Demographics
NPI:1942631296
Name:BENNETT, BETH ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:BROSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIV OF KY PEDIATRIC GASTROENTEROLOGY
Mailing Address - Street 2:138 LEADER AVE.
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-6192
Mailing Address - Fax:859-257-7799
Practice Address - Street 1:UNIV OF KY PEDIATRIC GASTROENTEROLOGY
Practice Address - Street 2:138 LEADER AVE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0001
Practice Address - Country:US
Practice Address - Phone:859-218-6192
Practice Address - Fax:859-257-7799
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1117376163W00000X
KY3008418363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner