Healthcare Provider Details

I. General information

NPI: 1730166307
Provider Name (Legal Business Name): WESLEY S BENNETT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CONSTITUTION AVE
MERIDIAN MS
39301-4001
US

IV. Provider business mailing address

2730 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5939
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-5322
  • Fax: 601-693-8081
Mailing address:
  • Phone: 337-369-9213
  • Fax: 337-367-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number10758
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: