MEDICARE: MRS. CHRISTINA L BENNETT RN, ANP, ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	542986	TX
2	363L00000X	Nurse Practitioner	AP111656	TX
3	363LA2200X	Adult Health Nurse Practitioner	542986	TX

General Provider Information

NPI Number	:	1104897149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA L BENNETT RN, ANP, ACNP

Provider Business Mailing Address
First Line	:	4907 CREEK SHADOWS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77339-1241
Country	:	US
Telephone Number	:	713-540-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-4412
Country	:	US
Telephone Number	:	281-348-8696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	03/04/2022

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