| Doctor Name: | MR. JUSTIN M BENNETT |
| NPI Number: | 1386637155 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | AP04254 |
| Business Practice Address: | 12489 Homeport Dr Ste D Maurepas, LA - 704493047 |
| Business Phone Number: | 2256983435 |
| Business Fax Number: | 2256986446 |
| Mailing Address: | 12273 Homeport Dr, MAUREPAS |
| State: | LA |
| Postal Code: | 704493027 |
| Phone Number: | 2256989578 |
| Fax Number: | |
| NPI Enumeration Date: | 08/26/2005 |
| NPI Last Update Date: | 04/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP04254 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |