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General NPI Number Information
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NPI Number | 1306341458
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Entity Type | Individual
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Provider Name | ASHLEY BENNETT
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 3111 WILLIAMSON COUNTY PKWY
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City | MARION
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State | IL
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Zip | 62959-5235
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Country | US
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Telephone | 618-997-3647
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Fax | 618-959-9437
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Provider Business Mailing Address
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Address Line | 2914 N PARK AVE
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City | HERRIN
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State | IL
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Zip | 62948-3522
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Country | US
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Telephone | 618-925-7790
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Fax | 844-270-4161
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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 | 209.032324
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.445121
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License Number State | IL
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