Provider Demographics
NPI:1689608978
Name:BENSON, MARY RUTH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RUTH
Last Name:BENSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:RUTH
Other - Last Name:DAVIS-BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:10501 NW 76TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1580
Mailing Address - Country:US
Mailing Address - Phone:816-714-6611
Mailing Address - Fax:
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-691-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO060205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO721D891Medicare ID - Type Unspecified