Provider Demographics
NPI:1306736814
Name:BENNETT, CAROL LOUISE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EVERGREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-0005
Mailing Address - Country:US
Mailing Address - Phone:304-931-9173
Mailing Address - Fax:
Practice Address - Street 1:305 EVERGREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-0005
Practice Address - Country:US
Practice Address - Phone:304-931-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant