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General NPI Number Information
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NPI Number | 1649662578
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Entity Type | Individual
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Provider Name | AUTUMN BENNETT WHNP-BC, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1003 FRED LAGRONE DR
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City | CROSSETT
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State | AR
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Zip | 71635-4546
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Country | US
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Telephone | 870-364-0577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX H
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City | CROSSETT
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State | AR
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Zip | 71635-1808
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Country | US
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Telephone | 870-364-0577
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | A004363
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | A004363
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License Number State | AR
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