Provider Demographics
NPI:1447230495
Name:BENSON, JESSICA DAWN (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:BENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 ALTA VIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:VA
Mailing Address - Zip Code:24380-4915
Mailing Address - Country:US
Mailing Address - Phone:540-488-4349
Mailing Address - Fax:
Practice Address - Street 1:282 ALTA VIEW DR SW
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:VA
Practice Address - Zip Code:24380-4915
Practice Address - Country:US
Practice Address - Phone:540-488-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206119207L00000X, 207LC0200X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447230495Medicaid
NC2403307Medicare PIN