Individual
KIM D BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8551
(304) 252-1790
Mailing address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8551
(304) 252-1790
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1988
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722123
BCBS
—
01
—
2145382
UNITEDHEALTHCARE
—
05
—
3004166000
—
WV
01
—
321488
CARELINK
—
05
—
54878
—
WV
05
—
58941
—
WV
01
—
H90133
HEALTH NET
—
Enumeration date
09/29/2006
Last updated
01/12/2025
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