Provider Demographics
NPI:1487242103
Name:BENNETT, PASHEN LECREST (LPN)
Entity type:Individual
Prefix:
First Name:PASHEN
Middle Name:LECREST
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W SILVER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4139
Mailing Address - Country:US
Mailing Address - Phone:405-264-3614
Mailing Address - Fax:
Practice Address - Street 1:5113 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3952
Practice Address - Country:US
Practice Address - Phone:405-600-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OKL0070081164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No175T00000XOther Service ProvidersPeer Specialist