Sally D Bennett, APRN BC FNP
Individual provider Active NPI Family Nurse Practitioner · Kingsland, GA
NPI 1336181536 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1336181536
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN094886 (GA)
- Practice address
- 130 N Gross Rd
Ste 201
Kingsland, GA 31548 - Phone
- (912) 729-2795
- Fax
- (912) 729-4117
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111222000496 | GA | Practitioner - Nurse Practitioner | 6305012378 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN094886 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camden Healthcare Associates, Inc. | Current |
Accepting new patients |
Locations
130 N Gross Rd
Ste 201
Kingsland, GA 31548
Phone (912) 729-2795
Interoperability endpoints
- sally.bennett.1@25110.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN094886 | GA | Yes |
Addresses
Primary practice location
130 N Gross Rd
Ste 201
Kingsland, GA 31548
Mailing address
130 N Gross Rd Ste 201
Kingsland, GA 31548-6277
Phone (912) 729-2795
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5000021728 | Other | GA | RR MC |
| 00830244C | Medicaid | GA | |
| 00830244D | Medicaid | GA |
Other providers in Kingsland, GA
- Marion Thomas Bailey Jr.
- Elizabeth G Barnett
- Hunter Beck
- Alejandra Benedit
- Codi Ann Bennett
- Best Life Day Center
- Kendall Beyl
- Matthew Shawn Biecker
- Tiffany Birt
- Leslie Elizabeth Blalock
All providers in Kingsland, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.