Provider Demographics
NPI:1336567676
Name:BENNETT, SHERREE (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHERREE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 WALZEM RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3641
Mailing Address - Country:US
Mailing Address - Phone:102-969-7400
Mailing Address - Fax:210-590-1054
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-922-2223
Practice Address - Fax:817-698-8471
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner