Provider Demographics
NPI:1952417255
Name:BENNETT, BETTY B (RN, CNS/PMH)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:B
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN, CNS/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FRIAR TUCK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3002
Mailing Address - Country:US
Mailing Address - Phone:912-398-4000
Mailing Address - Fax:912-354-7334
Practice Address - Street 1:32 FRIAR TUCK DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3002
Practice Address - Country:US
Practice Address - Phone:912-398-4000
Practice Address - Fax:912-354-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN025543 CNS/PMH163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult