Individual
BRENDA WAKHAM BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2569
(228) 867-4000
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2569
(228) 867-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R702285
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07051371
—
MS
Enumeration date
08/25/2006
Last updated
07/26/2024
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