Provider Demographics
NPI:1689223851
Name:KLEIN, BENTLEY LAUREN (NP)
Entity type:Individual
Prefix:
First Name:BENTLEY
Middle Name:LAUREN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GLYNCO PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-7930
Mailing Address - Country:US
Mailing Address - Phone:912-574-4313
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY STE 10
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7930
Practice Address - Country:US
Practice Address - Phone:912-574-4313
Practice Address - Fax:866-493-4020
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258118363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner