Healthcare Provider Details

I. General information

NPI: 1295595106
Provider Name (Legal Business Name): BENNETT SUPPLY AND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N WACO ST STE 220
WICHITA KS
67202-1102
US

IV. Provider business mailing address

245 N WACO ST STE 220
WICHITA KS
67202-1102
US

V. Phone/Fax

Practice location:
  • Phone: 316-722-2138
  • Fax: 833-464-2530
Mailing address:
  • Phone: 316-722-2138
  • Fax: 800-735-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAWNELE D TAYLOR
Title or Position: OWNER
Credential: APRN
Phone: 316-393-5256