Provider Demographics
NPI:1972826659
Name:BENNETT, HOLLY E (NP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-392-7000
Mailing Address - Fax:918-392-7013
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE 270
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-7000
Practice Address - Fax:918-392-7013
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168706363L00000X
OK116005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200583130AMedicaid
OK200583130AMedicaid