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Individual
KELLY A BENNETT
Active
Individual
KELLY A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02297
NC
363AM0700X
Medical Physician Assistant
0110002137
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010201683
—
VA
05
—
010201756
—
VA
Enumeration date
07/04/2006
Last updated
08/20/2024
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