Provider Demographics
NPI:1205022001
Name:BENJAMIN, KRISTEN HEATHER (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:HEATHER
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:HEATHER
Other - Last Name:STERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:1499 WALTON WAY
Mailing Address - Street 2:STE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-828-8401
Mailing Address - Fax:706-722-7235
Practice Address - Street 1:1499 WALTON WAY STE 1400
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2603
Practice Address - Country:US
Practice Address - Phone:706-828-8401
Practice Address - Fax:706-722-7235
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167843363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1454Medicaid
202I507284Medicare PIN