Provider Demographics
NPI:1972207264
Name:BENNETT, ABBYGAIL MIDDLETON (APRN)
Entity type:Individual
Prefix:
First Name:ABBYGAIL
Middle Name:MIDDLETON
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N MOUNT OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9509
Mailing Address - Country:US
Mailing Address - Phone:479-524-8175
Mailing Address - Fax:479-524-8176
Practice Address - Street 1:1500 N MOUNT OLIVE ST # 1
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9509
Practice Address - Country:US
Practice Address - Phone:479-524-8175
Practice Address - Fax:479-524-8176
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily