Provider Demographics
NPI:1790193340
Name:BENTON, STEPHANIE AMBER (ANP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AMBER
Last Name:BENTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4098
Mailing Address - Country:US
Mailing Address - Phone:210-481-6800
Mailing Address - Fax:210-481-7862
Practice Address - Street 1:11212 STATE HIGHWAY 151
Practice Address - Street 2:BLDG 2 , SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-681-5747
Practice Address - Fax:210-681-7515
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00485YMedicare PIN