Provider Demographics
NPI:1962659375
Name:BENKERT, KIM (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BENKERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:100 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5213
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:100 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5213
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist