Healthcare Provider Details

I. General information

NPI: 1487630273
Provider Name (Legal Business Name): KIMBERLY ANN BENNETT APRN, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S LIMESTONE
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

1573 LEESBURG PK
GEORGETOWN KY
40324
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5823
  • Fax: 859-323-1119
Mailing address:
  • Phone: 859-327-4709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA132
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3001937
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: