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General NPI Number Information
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NPI Number | 1467894089
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Entity Type | Individual
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Provider Name | NATHAN KYLE BENNETT PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 349 BOGLE ST SUITE B
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City | SOMERSET
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State | KY
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Zip | 42503-2895
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Country | US
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Telephone | 606-451-9448
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Fax | 606-451-9540
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Provider Business Mailing Address
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Address Line | 80 BROWN HILL SCHOOL RD
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City | FRAKES
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State | KY
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Zip | 40940-9523
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Country | US
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Telephone | 606-337-1832
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1804
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TC208
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1804
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License Number State | KY
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