Healthcare Provider Details

I. General information

NPI: 1255323390
Provider Name (Legal Business Name): JENNIFER GAY BENNETT F.N.P.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 FEDERAL HWY 80
RAYVILLE LA
71269-2957
US

IV. Provider business mailing address

755 ROACH RD
CHOUDRANT LA
71227-3633
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-2046
  • Fax: 318-728-9371
Mailing address:
  • Phone: 318-366-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04743
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: