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Individual

JOHN MARK BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
6010 W AMARILLO BLVD, AMARILLO, TX 79106-1990
(806) 355-7903
Mailing address
6010 W AMARILLO BLVD, AMARILLO, TX 79106-1990
(506) 355-7903

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
14100305061
KS
367500000X
Certified Registered Nurse Anesthetist
557038
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
AP123261
TX
390200000X
Student in an Organized Health Care Education/Training Program
14100305061
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200740430A
KS
Enumeration date
06/17/2011
Last updated
03/20/2024
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