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NPI Profile for JACKIE D BENNETT in MONTE VISTA, CO.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1174028849 |
|
| Status | Active | |
| Credentials | FNP-BC (Family Nurse Practitioner) | |
| Entity | Individual | |
| Enumeration date | 03/26/2018 | |
| Last updated | 09/12/2025 - About 9 months ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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JACKIE D BENNETT
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