Healthcare Provider Details

I. General information

NPI: 1457796005
Provider Name (Legal Business Name): BARBARA BRIGHT BENNETT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RANDY HENDRIX DR
BATESVILLE MS
38606-7664
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-9176
  • Fax: 662-563-7384
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-284-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP273116
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: