Provider Demographics
NPI:1740546084
Name:BENNETT, KIMBERLY LYN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 SPROUL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3509
Mailing Address - Country:US
Mailing Address - Phone:610-284-0200
Mailing Address - Fax:610-353-7932
Practice Address - Street 1:2000 SPROUL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3509
Practice Address - Country:US
Practice Address - Phone:610-284-0200
Practice Address - Fax:610-353-7932
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012058363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics