Basic Information
| Provider Information | |||||||||
| NPI: | 1366900318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | BAILEY | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 STILLWATER DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724049119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 502 E RACE AVE | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012683400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2019 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L059645 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.