Provider Demographics
NPI:1861931800
Name:BENNETT, BETTY GAYLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:GAYLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:GAYLE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4233 HIGHWAY 411
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-1571
Mailing Address - Country:US
Mailing Address - Phone:423-442-8084
Mailing Address - Fax:
Practice Address - Street 1:4233 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1571
Practice Address - Country:US
Practice Address - Phone:423-442-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN206845163W00000X
TN36195363LF0000X
TN32169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse