Provider Demographics
NPI:1912964503
Name:BENNETT, CHERIE (PA-C)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-339-2093
Mailing Address - Fax:830-282-6952
Practice Address - Street 1:711 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2261
Practice Address - Country:US
Practice Address - Phone:512-229-3334
Practice Address - Fax:877-662-9957
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q71621Medicare UPIN