Provider Demographics
NPI:1083382717
Name:BENSON, SCOTT KENNETH (AG-ACNPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KENNETH
Last Name:BENSON
Suffix:
Gender:M
Credentials:AG-ACNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402924
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2924
Mailing Address - Country:US
Mailing Address - Phone:804-533-0220
Mailing Address - Fax:
Practice Address - Street 1:9460 AMDERDALE DRIVE, SUITE E
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236
Practice Address - Country:US
Practice Address - Phone:804-533-0220
Practice Address - Fax:804-533-0230
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181457363LC0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine