MEDICARE: MS. KIMBERLY ANN BENNETT APRN, PA-C

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	363A00000X	Physician Assistant	PA132	KY
2	363LF0000X	Family Nurse Practitioner	3001937	KY

General Provider Information

NPI Number	:	1487630273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANN BENNETT APRN, PA-C

Provider Business Mailing Address
First Line	:	1573 LEESBURG PK
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324
Country	:	US
Telephone Number	:	859-327-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0284
Country	:	US
Telephone Number	:	859-323-5823
Fax Number	:	859-323-1119

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	03/07/2018

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