Individual
JASON W BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1323 W 6TH AVE, STILLWATER, OK 74074-4306
(405) 742-5300
(405) 742-4990
Mailing address
1323 W 6TH AVE, STILLWATER, OK 74074-4306
(405) 742-5300
(405) 742-4990
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55187
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010672601002
BCBSOK
OK
05
—
200109470A
—
OK
Enumeration date
04/25/2006
Last updated
12/21/2007
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