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General NPI Number Information
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NPI Number | 1295388379
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Entity Type | Individual
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Provider Name | ERIKA KAITLYN BENNETT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 140 TECHNOLOGY LN # LE
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2004
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Country | US
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Telephone | 423-434-2016
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 NW 136TH AVE BLDG H
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City | SUNRISE
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State | FL
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Zip | 33323-3091
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26403
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License Number State | TN
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