Provider Demographics
NPI:1891711552
Name:BENFORD, KIRSTEN ANGELIQUE (PNP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANGELIQUE
Last Name:BENFORD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1887
Mailing Address - Country:US
Mailing Address - Phone:972-249-5561
Mailing Address - Fax:
Practice Address - Street 1:6109 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5814
Practice Address - Country:US
Practice Address - Phone:866-492-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122926363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN