Bennett, Kelly A
Bennett, Kelly A is an individual health care provider with primary practice located at 1028 Lee Ann Dr Ne Ste 200 , Concord NC 28025-2915. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Bennett, Kelly A can be contacted via phone (704) 782-1892.Contact Information
Primary practice address
1028 Lee Ann Dr Ne Ste 200
Concord NC 28025-2915
Phone: (704) 782-1892
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 0110002137 | Virginia |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 0010-02297 | North Carolina |
Profile Details
| NPI number | 1982634762 |
|---|---|
| LBN Legal business name | Bennett, Kelly A |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2006 |
| Last updated | Oct 5th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982634762 | NPPES |
| Virginia | MEDICAID | 010201756 | |
| Virginia | MEDICAID | 010201683 |
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