Individual
TAMMY RENE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1525 FAIRFIELD AVE STE 569, OFFICE OF PUBLIC HEALTH, SHREVEPORT, LA 71101-4331
(318) 676-7483
(318) 676-7560
Mailing address
655 SR 333, RUSSELLVILLE, AR 72802-0963
(318) 470-1886
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN072119
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1435074
—
LA
Enumeration date
07/20/2006
Last updated
05/29/2024
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