Provider Demographics
NPI:1467242479
Name:BENNETT, DAVID ALLEN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 OAK GROVE RDG
Mailing Address - Street 2:
Mailing Address - City:FRIENDLY
Mailing Address - State:WV
Mailing Address - Zip Code:26146-8406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 OAK GROVE RDG
Practice Address - Street 2:
Practice Address - City:FRIENDLY
Practice Address - State:WV
Practice Address - Zip Code:26146-8406
Practice Address - Country:US
Practice Address - Phone:304-652-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide