Provider Demographics
NPI:1669698627
Name:BENNETT, JENNIFER LEAH (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEAH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 COUNTY ROAD 3355 E
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539
Mailing Address - Country:US
Mailing Address - Phone:512-932-2238
Mailing Address - Fax:512-932-8075
Practice Address - Street 1:811 S W S YOUNG DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4801
Practice Address - Country:US
Practice Address - Phone:254-690-5900
Practice Address - Fax:254-690-5908
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02003176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife