Individual
BENNETT W BICKNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(316) 685-6091
Mailing address
6060 PRIMACY PKWY, SUITE 241, MEMPHIS, TN 38119-5745
(901) 725-5846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
22953
MS
207L00000X
Anesthesiology Physician
Primary
24729
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117572
—
MS
05
—
130290001
—
AR
05
—
208593806
—
MO
01
—
3075049
BLUE CROSS BLUE SHIELD
TN
05
—
3080496
—
TN
01
—
97346
AR BLUE CROSS BLUE SHIELD
AR
01
—
9823478
CIGNA
—
01
—
AN99147
UNITED HEALTHCARE
—
Enumeration date
12/01/2005
Last updated
06/05/2024
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