Individual
JACKIE DAWN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
103 CHICO CT, MONTE VISTA, CO 81144-1065
(719) 852-9400
(719) 852-9311
Mailing address
371 PINON VALLEY RD, DEL NORTE, CO 81132-9014
(719) 588-1557
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0993785-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN0162822
RN
CO
Enumeration date
03/26/2018
Last updated
09/12/2025
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