Individual provider Active NPI

Penny Bennett, PHD, MSN, NNP-BC, FN

  • Neonatal Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1174899140
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
AP105453 Issued in TX
Practice address
5430 Fredericksburg Rd
Suite 508
San Antonio, TX 78229-3539
Phone
(210) 541-8281
Fax
(210) 541-9123
NPI assigned
Mar 23, 2012
Last updated
Dec 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Neonatal Nurse Practitioner 363LN0005X 539694 TX
Neonatal Nurse Practitioner 363LN0000X 105452 TX
Neonatal Nurse Practitioner 363LN0000X AP105453 TX Primary

Addresses

Primary practice location

5430 Fredericksburg Rd
Suite 508
San Antonio, TX 78229-3539

Mailing address

5430 Fredericksburg Rd
Suite 508
San Antonio, TX 78229-3539
Phone (210) 541-8281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041120000196 TX Practitioner - Nurse Practitioner 6800851783 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
105452TXMDSpeech-Language Pathologist
539694TXMDCritical Care Neonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children's Physician Group CurrentSince Sep 28, 2023 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Texas Children's Hospital Past Accepting new patients

Locations

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

6621 Fannin St
Houston, TX 77030
Phone (832) 824-1866

101 W Expressway 83
McAllen, TX 78503
Phone (956) 661-9840

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1174899140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD",
            "address_2": "SUITE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293539",
            "telephone_number": "210-541-8281",
            "fax_number": "210-541-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD",
            "address_2": "SUITE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293539",
            "telephone_number": "210-541-8281",
            "fax_number": "210-541-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "PENNY",
        "credential": "PHD, MSN, NNP-BC, FN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-23",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "TX",
            "license": "539694",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TX",
            "license": "105452",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TX",
            "license": "AP105453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.