Provider Demographics
NPI:1669341335
Name:BENNETT, PHELLON A (RN)
Entity type:Individual
Prefix:
First Name:PHELLON
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PIEDMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9458
Mailing Address - Country:US
Mailing Address - Phone:336-289-8648
Mailing Address - Fax:
Practice Address - Street 1:648 CONGRESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2749
Practice Address - Country:US
Practice Address - Phone:945-900-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse