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General NPI Number Information
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NPI Number | 1598003808
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Entity Type | Individual
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Provider Name | KEISHA SIMONE BENNETT FNP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2013
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Last Update Date | 01/21/2013
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Provider Practice Location Address
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Address Line | 451 CLARKSON AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2054
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Country | US
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Telephone | 718-245-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 610 E 38TH ST
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City | BROOKLYN
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State | NY
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Zip | 11203-5610
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Country | US
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Telephone | 718-941-7771
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337490-1
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License Number State | NY
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