Provider Demographics
NPI:1356392807
Name:BENNETT, PAMELA JOY (PCNS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JOY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:BLDG D305
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-789-4013
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:BLDG D305
Practice Address - City:N.K
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-788-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN15994163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
5366082OtherFIRST HEALTH
1020870OtherBEACON HEALTH
494590OtherTUFTS HEALTH PLAN
6236650OtherUNITED HEALTH CARE
RI21221-4OtherRI BC/BS
6236650OtherUNITED HEALTH CARE