Provider Demographics
NPI:1043656291
Name:BENNETT, RACHEL MEADOR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MEADOR
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MEADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2111 NEUSE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4318
Mailing Address - Country:US
Mailing Address - Phone:252-636-0300
Mailing Address - Fax:
Practice Address - Street 1:57 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7327
Practice Address - Country:US
Practice Address - Phone:910-353-4414
Practice Address - Fax:910-353-2972
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-04222OtherNC LICENSE
NC0010-04222OtherNC LICENSE