Healthcare Provider Details

I. General information

NPI: 1811535594
Provider Name (Legal Business Name): KARSON JOY BENNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 COLLEGE WAY N
SEATTLE WA
98103-3514
US

IV. Provider business mailing address

10718 38TH AVE NE
SEATTLE WA
98125-7906
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-5124
  • Fax:
Mailing address:
  • Phone: 206-245-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00078999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: