Provider Demographics
NPI:1689820284
Name:BENTON, LEMKHAM (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LEMKHAM
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8610
Mailing Address - Country:US
Mailing Address - Phone:352-596-4306
Mailing Address - Fax:
Practice Address - Street 1:7007 GROVE ROAD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34609
Practice Address - Country:US
Practice Address - Phone:352-596-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2019-06-06
Deactivation Date:2019-03-27
Deactivation Code:
Reactivation Date:2019-06-06
Provider Licenses
StateLicense IDTaxonomies
FL9276372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty