Healthcare Provider Details

I. General information

NPI: 1770265274
Provider Name (Legal Business Name): RACHEL BENNETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MEDICAL DR
DOTHAN AL
36303-6902
US

IV. Provider business mailing address

201 DEFENSE HWY STE 205
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-7808
  • Fax: 334-288-8089
Mailing address:
  • Phone: 855-527-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: