KELLY RANDOLPH BENNETT (NPI# 1134302722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134302722 |
| Entity Type | Individual |
| Full Name | KELLY RANDOLPH BENNETT |
| Credential | PHD |
| Practice Address |
578 Via Arista Santa Fe NM 87506-4507 |
| Mailing Address |
Po Box 9880 Santa Fe NM 87504-9880 |
| Practice Telephone | 5055771862 |
| Practice Fax Number | 5054669459 |
| Mailing Telephone | 5055771862 |
| Mailing Fax Number | 5054669459 |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2008-04-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC1900X |
Psychologist Specialization: Counseling |
MFC 2017 | CA | Behavioral Health & Social Service Providers |
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
LPCC 0088061 | NM | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578033387 | Kelly S Bennett | Counselor | 11100 Highway 1078, Folsom, LA 70437-3501 | 2018-12-05 |
| 1831101641 | Kelly Angela Bennett | Specialist | 1161 21st Avenue South R 1217 Medical Center North, Vanderbilt University, Nashville, TN 37232 | 2006-08-12 |
| 1982634762 | Kelly A Bennett | Physician Assistant | 1028 Lee Ann Dr Ne Ste 200, Concord, NC 28025-2915 | 2006-07-04 |
| 1891184875 | Kelly Bennett | Nurse Practitioner | 4921 Long Prairie Rd, Suite 100, Flower Mound, TX 75028-2716 | 2015-01-14 |
| 1013329481 | Kelly Bennett | Counselor | 2711 W 15th St, Panama City, FL 32401-1366 | 2014-05-20 |
| 1083999247 | Kelly Bennett | Pharmacist | 1191 Dixwell Ave, Hamden, CT 06514-4733 | 2011-10-19 |
| 1306136460 | Kelly M Bennett | Pediatrics | 6010 S Mason Montgomery Rd, Mason, OH 45040-3706 | 2011-04-11 |
| 1144356437 | Kelly Marie Bennett | Counselor | 1500 North Ritter Avenue, Indianapolis, IN 46219-3027 | 2007-02-23 |
| 1063404127 | Kelly A. Bennett | Family Medicine | 3601 4th St, Lubbock, TX 79430-0002 | 2005-08-16 |
| Street Address |
578 VIA ARISTA |
| City | SANTA FE |
| State | NM |
| Zip Code | 87506-4507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073110920 | Nambe Pueblo | Clinic/Center | 16a Tayeh Huu U, Pueblo of Nambe, NM 87506 | 2020-10-05 |
| 1811543655 | Waltor Surgical Assisting | Specialist/Technologist, Other | 708 Luna Vista, Santa Fe, NM 87506 | 2019-08-16 |
| 1518447762 | Rosario Cismowski Escobedo | Behavior Technician | 17709a Hwy 84/285, Santa Fe, NM 87506 | 2018-08-17 |
| 1417440777 | Las Clinicas Del Norte Incorporated | Clinic/Center | 1797b St. Rd 502, Santa Fe, NM 87506 | 2018-06-12 |
| 1992297915 | Carnell D Horn II | Behavior Technician | 44 Paseo Encantado Sw, Santa Fe, NM 87506 | 2018-06-05 |
| 1689101594 | James M Mccaffery | Ophthalmology | 45 Violet Circle, Santa Fe, NM 87506 | 2017-05-23 |
| 1225404437 | Tiffany Wynn | Counselor | 1524 Bishops Lodge Rd, #b, Tesuque, NM 87506 | 2015-08-12 |
| 1912119298 | St Vincent Hospital | General Acute Care Hospital | 5 Petroglyph Circle, Suite A, Pojoaque, NM 87506 | 2007-05-07 |
| 1881733574 | Kathleen Ohringer Paster | Social Worker | 53 Heartstone Drive, Santa Fe, NM 87506 | 2007-02-06 |
| 1831269448 | Roberta R Goodman | Counselor | 187 Tesuque Village Rd, Tesuque, NM 87506 | 2006-11-09 |
| Find all providers in zip 87506 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417564568 | Sacred Soul Psychology Inc | Psychologist | 4362 Village Loop, Santa Fe, NM 87507-1833 | 2020-09-23 |
| 1154792919 | James M Nolan | Psychologist | 4719 Contenta Rdg, Santa Fe, NM 87507-6603 | 2015-10-19 |
| 1396977849 | Meryl Leiberman | Psychologist | 49 Camino Bajo, Santa Fe, NM 87508-8614 | 2009-08-18 |
| 1710126651 | Harmony for Life LLC | Psychologist | 522 S Saint Francis Dr, Santa Fe, NM 87501-3057 | 2009-02-17 |
| 1346417490 | Dana Michelle Udall-weiner | Psychologist | 1301 Luisa St, Suite E, Santa Fe, NM 87505-7001 | 2008-05-08 |
| 1003830415 | Kathleen O'malley Reyntjens | Psychologist | 110 Delgado St, Suite A, Santa Fe, NM 87501-2781 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366056 | Katherine Imislund-clark, Lpcc | Psychologist | 122 Girard Blvd Se Apt B, Albuquerque, NM 87106-2286 | 2020-11-02 |
| 1952901647 | Debra Ann Carter Lpcc LLC | Psychologist | 3321b Candelaria Rd Ne Ste 402, Albuquerque, NM 87107-1908 | 2020-10-30 |
| 1831710490 | Zia Community Cares, LLC | Psychologist | 5400 Gibson Blvd, Building 11, Albuquerque, NM 87108-8710 | 2020-05-05 |
| 1962974600 | Jeffrey Alan Franken | Psychologist | 9 Calle Ponderosa, Placitas, NM 87043-9328 | 2018-12-19 |
| 1629558838 | Ocotillo Psychological Services LLC | Psychologist | 2801 Missouri Ave Ste 36, Las Cruces, NM 88011-9151 | 2018-08-16 |
| 1770087520 | Catherine Hammitt | Psychologist | 701 Los Lentes Rd Ne, Los Lunas, NM 87031-7362 | 2018-03-19 |
| 1629585534 | Tracie Hitter | Psychologist | 1830 Myrtle Ave, Las Cruces, NM 88001-5245 | 2018-01-02 |
| 1528450061 | Giving Tree Counseling, LLC | Psychologist | 8901 San Diego Ave Ne, Albuquerque, NM 87122-3636 | 2015-02-20 |
| 1417394628 | Eve M Adams | Psychologist | 1220 Stewart St, O'donnell Hall, Rm 205, Las Cruces, NM 88003 | 2013-05-29 |
| 1013296219 | Amy Sholler Dreier | Psychologist | 208 D.l. Ingram Ave, Cannon Mental Health Clinic, Cannon Afb, NM 88103-5014 | 2011-08-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.