Provider Demographics
NPI:1750525853
Name:BENTLEY, BRENDA ARLENE (FNP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ARLENE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N JOHN B DENNIS HWY
Mailing Address - Street 2:APT 1110
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-0812
Mailing Address - Country:US
Mailing Address - Phone:423-502-1312
Mailing Address - Fax:
Practice Address - Street 1:2995 FORT HENRY DR
Practice Address - Street 2:STE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4070
Practice Address - Country:US
Practice Address - Phone:423-502-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner