Provider Demographics
NPI:1528754314
Name:BENNETT, CHRISTAL HAYES (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:HAYES
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 CABARRUS AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3781
Mailing Address - Country:US
Mailing Address - Phone:855-743-2247
Mailing Address - Fax:855-857-7333
Practice Address - Street 1:101 CABARRUS AVE E STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3781
Practice Address - Country:US
Practice Address - Phone:855-743-2247
Practice Address - Fax:855-857-7333
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018460363LP0808X
NC273255163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health