Provider Demographics
NPI:1417188285
Name:KISER, BENJAMIN LUKE (ARNP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
Last Name:KISER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HIGHWAY 3086
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-9204
Mailing Address - Country:US
Mailing Address - Phone:276-212-1131
Mailing Address - Fax:276-212-1195
Practice Address - Street 1:214 HIGHWAY 3086
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-9204
Practice Address - Country:US
Practice Address - Phone:606-212-1131
Practice Address - Fax:606-212-1195
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47901363LF0000X
VA0024172025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100100220Medicaid
KY1417188285Medicaid
VA1417188285Medicaid
VAP01574211OtherRAILROAD MEDICARE
VAVVI931AMedicare PIN