Healthcare Provider Details

I. General information

NPI: 1942631296
Provider Name (Legal Business Name): BETH ANN BENNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. BETH ANN BROSEY

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIV OF KY PEDIATRIC GASTROENTEROLOGY 138 LEADER AVE
LEXINGTON KY
40506-0001
US

IV. Provider business mailing address

UNIV OF KY PEDIATRIC GASTROENTEROLOGY 138 LEADER AVE.
LEXINGTON KY
40506-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-6192
  • Fax: 859-257-7799
Mailing address:
  • Phone: 859-218-6192
  • Fax: 859-257-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008418
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3008418
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1117376
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: