Healthcare Provider Details

I. General information

NPI: 1326317256
Provider Name (Legal Business Name): MINDY S BENNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BAKER PLACE MINERAL COUNTY BOARD OF EDUCATION
KEYSER WV
26726
US

IV. Provider business mailing address

ONE BAKER PLACE MINERAL COUNTY BOARD OF EDUCATION
KEYSER WV
26726
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 304-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 304-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number52423
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: