Provider Demographics
NPI:1912905985
Name:BENNETT, ASHLEY J (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 WILKINSON TRCE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3404
Mailing Address - Country:US
Mailing Address - Phone:270-781-4043
Mailing Address - Fax:270-781-4196
Practice Address - Street 1:990 WILKINSON TRCE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3404
Practice Address - Country:US
Practice Address - Phone:270-781-4043
Practice Address - Fax:270-781-4196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64070196Medicaid
KYH91136Medicare UPIN
KY1940401Medicare ID - Type Unspecified