Provider Demographics
NPI:1356735955
Name:BENNETT, WILLIAM SHAYNE (APRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SHAYNE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-0417
Mailing Address - Fax:606-408-6069
Practice Address - Street 1:2420 ARGILLITE RD STE B
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1972
Practice Address - Country:US
Practice Address - Phone:606-836-3900
Practice Address - Fax:606-836-0205
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily