MEDICARE: MRS. RACHEL BENNETT FNP

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	363LF0000X	Family Nurse Practitioner	1-145986	AL

General Provider Information

NPI Number	:	1770265274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL BENNETT FNP

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY STE 205
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7096
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 MEDICAL DR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-6902
Country	:	US
Telephone Number	:	334-288-7808
Fax Number	:	334-288-8089

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	05/19/2026

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