Provider Demographics
NPI:1982687992
Name:BENNETT, JANET S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:S
Last Name:BENNETT
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 1:434 DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1433
Mailing Address - Country:US
Mailing Address - Phone:304-766-6335
Mailing Address - Fax:304-766-0338
Practice Address - Street 1:434 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1433
Practice Address - Country:US
Practice Address - Phone:304-766-6335
Practice Address - Fax:304-766-0338
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily