Healthcare Provider Details

I. General information

NPI: 1457862237
Provider Name (Legal Business Name): CHANTEL BENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR STE 300
AUSTIN TX
78758-5386
US

IV. Provider business mailing address

2200 PARK BEND DR STE 300
AUSTIN TX
78758-5386
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax:
Mailing address:
  • Phone: 512-836-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: