Healthcare Provider Details

I. General information

NPI: 1164650420
Provider Name (Legal Business Name): KAREN WEBB BENNETT PHD, RD, MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

110 W WALKER AVE
ASHEBORO NC
27203-6760
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-1517
  • Fax: 919-363-7697
Mailing address:
  • Phone: 336-633-7000
  • Fax: 336-625-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number191449
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200950062NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1323
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5005937
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: