Bennett, Kelly A.

Bennett, Kelly A. is an individual health care provider with primary practice located at 3601 4Th St , Lubbock TX 79430-0002. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Bennett, Kelly A. can be contacted via phone (806) 743-2757.

Contact Information

Primary practice address
3601 4Th St Lubbock TX 79430-0002
Phone: (806) 743-2757
Fax: (806) 743-2563
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X K0417 Texas

Profile Details

NPI number 1063404127
LBN Legal business name Bennett, Kelly A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jan 10th, 2020 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063404127 NPPES
New Mexico Other A297 TRIWEST
New Mexico MEDICAID 100155840A TRIWEST
New Mexico MEDICAID 117701603 TRIWEST
New Mexico Other 108429102 TRIWEST
New Mexico Other 87813G TRIWEST
New Mexico MEDICAID 108429103 TRIWEST
New Mexico MEDICAID 117701602 TRIWEST
New Mexico Other 83027Z TRIWEST
New Mexico Other 62147 TRIWEST
New Mexico MEDICAID T9668 TRIWEST

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