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General NPI Number Information
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NPI Number | 1578533345
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Entity Type | Individual
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Provider Name | AMANDA K BENNETT MD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 2585 3RD AVENUE
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City | HUNTINGTON
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State | WV
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Zip | 25703
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Country | US
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Telephone | 304-781-5138
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1680
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City | HUNTINGTON
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State | WV
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Zip | 25707-1680
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Country | US
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Telephone | 304-697-1396
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Fax | 304-697-2086
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101238081
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21674
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License Number State | WV
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