1467730127 NPI number — REBEKAH J BENNETT CRNA

Table of content: REBEKAH J BENNETT CRNA (NPI 1467730127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467730127 NPI number — REBEKAH J BENNETT CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
REBEKAH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467730127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4976 ALPHA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-5470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-497-5355
Provider Business Mailing Address Fax Number:
423-308-0281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 GUNBARREL RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-3289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-308-0390
Provider Business Practice Location Address Fax Number:
423-308-0393
Provider Enumeration Date:
07/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APN15951 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1525881 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003113481A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003113481C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4306850 . This is a "BCBS OF TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003113181B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003113481D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00983456 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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