Healthcare Provider Details

I. General information

NPI: 1356735955
Provider Name (Legal Business Name): WILLIAM SHAYNE BENNETT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ARGILLITE RD STE B
FLATWOODS KY
41139-1972
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-3900
  • Fax: 606-836-0205
Mailing address:
  • Phone: 606-408-0417
  • Fax: 606-408-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009174
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: