Provider Demographics
NPI:1023538139
Name:BENKO, DARRELL ELLIOTT (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:ELLIOTT
Last Name:BENKO
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 MARCILLUS AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-5340
Mailing Address - Country:US
Mailing Address - Phone:915-540-0263
Mailing Address - Fax:
Practice Address - Street 1:221 N KANSAS ST STE 700
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1443
Practice Address - Country:US
Practice Address - Phone:915-307-9034
Practice Address - Fax:855-611-1917
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704395712363LA2200X
AZ248267363LA2200X
AR220021363LA2200X
ID65923363LA2200X
IN71013102A363LA2200X
KY3018335363LA2200X
LA223728363LA2200X
MS905140363LA2200X
NV847896363LA2200X
NM56805363LA2200X
WAAP61137506363LA2200X
IAH171191364SA2200X
TXAP134227363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health