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General NPI Number Information
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NPI Number | 1407141443
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Entity Type | Individual
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Provider Name | JOHN MARK BENNETT CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 6010 W AMARILLO BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1990
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Country | US
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Telephone | 806-355-7903
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 W AMARILLO BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1990
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Country | US
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Telephone | 506-355-7903
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 557038
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 14100305061
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP123261
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 14100305061
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License Number State | KS
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