Provider Demographics
NPI:1689083750
Name:BENNETT, BISONA YEBA (FNP)
Entity type:Individual
Prefix:DR
First Name:BISONA
Middle Name:YEBA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:DR
Other - First Name:BISONA
Other - Middle Name:YEBA
Other - Last Name:TITALANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:702 FREEMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2181
Mailing Address - Country:US
Mailing Address - Phone:210-219-1160
Mailing Address - Fax:
Practice Address - Street 1:120 HELMWOOD PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-600-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011151363LF0000X
TXAP126077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily