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General NPI Number Information
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NPI Number | 1245871417
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Entity Type | Individual
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Provider Name | RYGINNA D BENNETT NP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 300 S WASHINGTON AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-4719
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Country | US
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Telephone | 662-378-2020
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Fax | 662-725-2505
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Provider Business Mailing Address
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Address Line | 10443 LONG BRIDGE RD S
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4521
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Country | US
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Telephone | 662-822-3504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 903567
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License Number State | MS
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