Individual
JUSTIN BAINES BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4314 WILLIAMSTOWN PIKE, WILLIAMSTOWN, WV 26187-8083
(304) 482-6029
Mailing address
4314 WILLIAMSTOWN PIKE, WILLIAMSTOWN, WV 26187-8083
(304) 482-6029
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
RN.385551
OH
207Q00000X
Family Medicine Physician
LE-00038485
OH
363LF0000X
Family Nurse Practitioner
Primary
110892
WV
Other
Enumeration date
09/20/2021
Last updated
02/09/2022
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