Provider Demographics
NPI:1396808150
Name:BENNETT, JODI C (CNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3332
Mailing Address - Country:US
Mailing Address - Phone:740-775-6119
Mailing Address - Fax:740-775-6999
Practice Address - Street 1:311 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3332
Practice Address - Country:US
Practice Address - Phone:740-775-6119
Practice Address - Fax:740-775-6999
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.05280363LF0000X
OHCOA.05280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000346088OtherPROVIDER BCBS NUMBER
OHP74949Medicare UPIN
OHNP11812Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER