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General NPI Number Information
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NPI Number | 1396489936
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Entity Type | Individual
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Provider Name | DAVID P BENNETT AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER BLVD STE 200
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City | CONROE
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State | TX
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Zip | 77304-2821
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Country | US
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Telephone | 936-441-9680
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Fax |
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Provider Business Mailing Address
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Address Line | 12702 IVYFOREST DR
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City | CYPRESS
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State | TX
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Zip | 77429-2014
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Country | US
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Telephone | 512-755-6342
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 829530
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1107084
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License Number State | TX
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