Active NPI
Kanya Bennett, LMP
- Community Health Worker
- Bremerton, WA
National Provider Identifier
1447794375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- MA60592776
- Practice address
- 2817 Wheaton Way Ste 104C
Bremerton, WA 98310-3440 - Phone
- (360) 377-0725
- NPI assigned
- Dec 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | MA60592776 | WA | Primary |
Addresses
Primary practice location
2817 Wheaton Way Ste 104C
Bremerton, WA 98310-3440
Mailing address
2817 Wheaton Way Ste 104C
Bremerton, WA 98310-3440
Phone (360) 377-0725
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA60592776 | Other | WA | WASHINGTON STATE HEALTH DEPT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60592776 | WA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481500800000",
"number": "1447794375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 WHEATON WAY STE 104C",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983103440",
"telephone_number": "360-377-0725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 WHEATON WAY STE 104C",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983103440",
"telephone_number": "360-377-0725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "KANYA",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-12",
"last_updated": "2016-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "WA",
"license": "MA60592776",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE HEALTH DEPT",
"identifier": "MA60592776",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.