Provider Demographics
NPI:1538852314
Name:BENNETT, JAMIE RAE (RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 GLENWOOD PARK RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-7969
Mailing Address - Country:US
Mailing Address - Phone:304-323-2300
Mailing Address - Fax:866-597-0956
Practice Address - Street 1:1908 GLENWOOD PARK RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-7969
Practice Address - Country:US
Practice Address - Phone:304-323-2300
Practice Address - Fax:866-597-0956
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92796163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health