MEDICARE: JIMMIE BENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1003732439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMIE BENNETT

Provider Business Mailing Address
First Line	:	10438 CASTLETON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 CYPRESS CREEK PKWY STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3562
Country	:	US
Telephone Number	:	281-713-4775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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Directions to “ JIMMIE BENNETT ” Practice Location

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