Provider Demographics
NPI:1174016539
Name:BENGSTON, EMILY (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BENGSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FM 2181 STE 100
Mailing Address - Street 2:
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7636
Mailing Address - Country:US
Mailing Address - Phone:940-498-4422
Mailing Address - Fax:940-321-1045
Practice Address - Street 1:3600 FM 2181 STE 100
Practice Address - Street 2:
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7636
Practice Address - Country:US
Practice Address - Phone:940-498-4422
Practice Address - Fax:940-321-1045
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant