Provider Demographics
NPI:1336486422
Name:BENNETT, COURTNEY ANITA HAMPTON (APMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ANITA HAMPTON
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 22ND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4013
Mailing Address - Country:US
Mailing Address - Phone:601-686-6500
Mailing Address - Fax:
Practice Address - Street 1:1201 22ND AVE STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4013
Practice Address - Country:US
Practice Address - Phone:601-686-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02700224Medicaid
MS294918YS54Medicare PIN