Active NPI
Chalonnie Bennett, RN
- Registered Nurse
- Fort Leonard Wood, MO
National Provider Identifier
1851608905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN170946
- Practice address
- 126 Missouri Ave
Fort Leonard Wood, MO 65473-8952 - Phone
- (912) 271-1387
- NPI assigned
- Sep 10, 2010
- Reactivated
- Jun 16, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN170946 | GA | Primary |
Addresses
Primary practice location
126 Missouri Ave
Fort Leonard Wood, MO 65473-8952
Mailing address
108 Neal St
Fort Leonard Wood, MO 65473-8035
Phone (912) 271-1387
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN170946 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1851608905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 NEAL ST",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654738035",
"telephone_number": "912-271-1387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 MISSOURI AVE",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654738952",
"telephone_number": "912-271-1387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "CHALONNIE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-10",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"deactivation_date": "2017-02-15",
"reactivation_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "RN170946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Leonard Wood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.