Provider Demographics
NPI:1457303976
Name:BENEDICT, JENNIFER ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E LANTRIP ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-5956
Mailing Address - Country:US
Mailing Address - Phone:903-983-0081
Mailing Address - Fax:903-983-0082
Practice Address - Street 1:401 E LANTRIP ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5956
Practice Address - Country:US
Practice Address - Phone:903-983-0081
Practice Address - Fax:903-983-0082
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX824N42OtherBCBS
TXTIN PLUS 022OtherTRICARE
TXTXB105420Medicare Oscar/Certification
TX824N42OtherBCBS
TX8J2548Medicare ID - Type Unspecified
TXQ77078Medicare UPIN
TX213267201Medicaid