Provider Demographics
NPI:1083197016
Name:BENTON, JOCELYN ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ASHLEY
Last Name:BENTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 E FLAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3102
Mailing Address - Country:US
Mailing Address - Phone:208-442-8035
Mailing Address - Fax:
Practice Address - Street 1:3908 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3102
Practice Address - Country:US
Practice Address - Phone:208-442-8035
Practice Address - Fax:208-442-8038
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2019-11-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant