Provider Demographics
NPI:1013684760
Name:BENNETT, KATHERINE (APN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 WELLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4265
Mailing Address - Country:US
Mailing Address - Phone:423-883-5476
Mailing Address - Fax:
Practice Address - Street 1:7480 ZIEGLER RD STE 150
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4947
Practice Address - Country:US
Practice Address - Phone:423-933-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner