NATHANIEL D BENNETT (NPI# 1427076637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427076637 |
| Entity Type | Individual |
| Full Name | NATHANIEL D BENNETT |
| Credential | PAC |
| Practice Address |
1970 Roanoke Blvd Salem VA 24153-6404 |
| Mailing Address |
3343 Clara Ave Sw Roanoke VA 24018-1301 |
| Practice Telephone | 5409822463 |
| Mailing Telephone | 5403621594 |
| Mailing Fax Number | 2762368899 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
0110-001867 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 010116309 | 05 |
| Street Address |
1970 ROANOKE BLVD |
| City | SALEM |
| State | VA |
| Zip Code | 24153-6404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518960301 | Paul Shearer | Podiatrist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2005-05-24 |
| 1821697301 | Tammy C'w Yu | Pharmacist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-10-26 |
| 1649886599 | Rebecca Elizabeth Stevenson | Psychologist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-09-16 |
| 1013529098 | Salihah Ali | Pharmacist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-08-20 |
| 1043838303 | Jasper Jade Dikit Raguindin | Pharmacist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-07-13 |
| 1568080976 | Morgan Cook | Pharmacist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-07-13 |
| 1508484528 | Lisa M Harrison | Nurse Practitioner | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-07-07 |
| 1417575432 | Hannah Wilkoff | Pharmacist | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-07-07 |
| 1952928764 | Stephanie Nicole May | Nurse Practitioner | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2020-06-26 |
| 1396369336 | Callie Mashburn | Optometrist | 1970 Roanoke Blvd, Salem, VA 24153-6478 | 2020-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669001228 | Paul Mcguire | Student in an Organized Health Care Education/Training Program | 1906 Braeburn Drive Psychiatry Gme, Salem, VA 24153 | 2020-04-06 |
| 1386114965 | Dynamic Medical LLC | Clinical Medical Laboratory | 1201 Texas Street, Salem, VA 24153 | 2018-11-27 |
| 1134607898 | Renew Psychiatry Services | Psychiatry & Neurology | 177 Electric Rd, Salem, VA 24153 | 2018-08-03 |
| 1508304015 | Samantha Getz | Assisted Living Facility | 3706 Knollridge Rd., Salem, VA 24153 | 2017-02-03 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1154729051 | Allison Marie Parry | Physician Assistant | 1336 W Main St., Salem, VA 24153 | 2014-12-09 |
| 1598199457 | Stacy Stanley | Occupational Therapy Assistant | 4812 Moore Rd, Salem, VA 24153 | 2013-08-28 |
| 1366888034 | Dolores Hager | Speech-Language Pathologist | 1851 Harrogate Dr, Salem, VA 24153 | 2013-05-21 |
| 1073850764 | Joel Aaron Nickerson | Specialist/Technologist | 400 Spartan Dr., Salem High School, Salem, VA 24153 | 2013-01-15 |
| 1023387271 | National Diabetic Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 2153 Apperson Drive, Salem, VA 24153 | 2011-12-16 |
| Find all providers in zip 24153 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
| 1639614852 | Gregory Bull | Physician Assistant | 622 Fernwood Dr, Salem, VA 24153-2654 | 2016-12-24 |
| 1841648862 | Theron J Wiese | Physician Assistant | 1395 Commercial St Se, Salem, OR 97302-4205 | 2016-05-31 |
| 1922329697 | Charleen Ann Thorburn | Physician Assistant | 22 Keewaydin Dr, Salem, NH 03079-2839 | 2010-06-17 |
| 1316188006 | Judith A Mitchell | Physician Assistant | 4999 Skyline Rd. S., Salem, OR 97306 | 2009-03-10 |
| 1215912712 | Amy Gouley | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2005-12-07 |
| 1306827100 | William Earle Williams | Physician Assistant | 1233 Edgewater St Nw, Salem, OR 97304-4049 | 2005-11-08 |
| 1700485224 | Roderick Mao | Physician Assistant | 159 N Broadway, Salem, NH 03079-2136 | 2020-10-26 |
| 1447719752 | Christine Nicole Jeffries | Physician Assistant | 360 Church St Se, Salem, OR 97301-3796 | 2019-03-16 |
| 1265999338 | Brolin Johnson | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2019-02-26 |
| Find all providers in SALEM | ||||
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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.