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Individual
KELLY A. BENNETT
Active
Individual
KELLY A. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K0417
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100155840A
—
OK
01
—
108429102
FIRSTCARE COMMERCIAL
TX
05
—
108429103
—
TX
05
—
117701602
—
TX
05
—
117701603
—
TX
01
—
62147
PRESBYTERIAN COMMERCIAL
NM
01
—
83027Z
HMO BLUE
TX
01
—
87813G
BCBS
TX
01
—
A297
TRIWEST
NM
05
—
T9668
—
NM
Enumeration date
08/16/2005
Last updated
01/10/2020
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