Basic Information
| Provider Information | |||||||||
| NPI: | 1750767224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 BULL ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314014347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502600 | ||||||||
| FaxNumber: | 9123501148 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 BULL ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314014347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502600 | ||||||||
| FaxNumber: | 9123501148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2015 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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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 | 363LA2200X | RN213094 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | RN213094 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.