Provider Demographics
NPI:1245871417
Name:BENNETT, RYGINNA D (NP)
Entity type:Individual
Prefix:
First Name:RYGINNA
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10443 LONG BRIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4521
Mailing Address - Country:US
Mailing Address - Phone:662-822-3504
Mailing Address - Fax:
Practice Address - Street 1:300 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4719
Practice Address - Country:US
Practice Address - Phone:662-378-2020
Practice Address - Fax:662-725-2505
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903567363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health