Provider Demographics
NPI:1164748638
Name:BENTON, JENNIFER DEANN (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DEANN
Last Name:BENTON
Suffix:
Gender:F
Credentials:NP
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 3387
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3387
Mailing Address - Country:US
Mailing Address - Phone:828-584-1105
Mailing Address - Fax:
Practice Address - Street 1:810 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4235
Practice Address - Country:US
Practice Address - Phone:252-499-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004929Medicaid
NC6113151Medicaid
NCNC9654AMedicare PIN