Provider Demographics
NPI:1538356837
Name:BENNETT, CARRIE HEATHER (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:HEATHER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2476 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5377
Mailing Address - Country:US
Mailing Address - Phone:770-951-1565
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:2476 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5377
Practice Address - Country:US
Practice Address - Phone:770-951-1565
Practice Address - Fax:770-573-9513
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073471163W00000X
GARN237110363L00000X
IN28240019A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse