Provider Demographics
NPI:1770299604
Name:BENNETT, KHALEEAH B
Entity type:Individual
Prefix:
First Name:KHALEEAH
Middle Name:B
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 SUTTERTON LN
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5230
Mailing Address - Country:US
Mailing Address - Phone:513-928-1904
Mailing Address - Fax:
Practice Address - Street 1:5663 SUTTERTON LN
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5230
Practice Address - Country:US
Practice Address - Phone:513-928-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide