Provider Demographics
NPI:1730790346
Name:BENNORTH, KAITLYN AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:AMANDA
Last Name:BENNORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PLOUGHMANS BEND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4259
Mailing Address - Country:US
Mailing Address - Phone:615-428-6123
Mailing Address - Fax:
Practice Address - Street 1:200 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2677
Practice Address - Country:US
Practice Address - Phone:615-771-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty