Healthcare Provider Details

I. General information

NPI: 1154252690
Provider Name (Legal Business Name): MEGAN BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E DRAPER DR
SALISBURY MO
65281-9606
US

IV. Provider business mailing address

604 E DRAPER DR
SALISBURY MO
65281-9606
US

V. Phone/Fax

Practice location:
  • Phone: 660-414-5740
  • Fax:
Mailing address:
  • Phone: 660-414-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2019019701
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: