MEDICARE: MRS. KAYLEE JOANNE BENNETT FNP-C

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	163W00000X	Registered Nurse	840524	TX
2	363LF0000X	Family Nurse Practitioner	AP141980	TX

General Provider Information

NPI Number	:	1487215935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLEE JOANNE BENNETT FNP-C

Provider Business Mailing Address
First Line	:	1295 PEARL ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-3642
Country	:	US
Telephone Number	:	409-554-6360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 PEARL ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-3642
Country	:	US
Telephone Number	:	409-554-6360
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	03/11/2022

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