Provider Demographics
NPI:1245980101
Name:BENSON, DESIREE MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MICHELLE
Last Name:BENSON
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 1:1140 WESTMONT DR STE 425
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4358
Mailing Address - Country:US
Mailing Address - Phone:713-453-4395
Mailing Address - Fax:
Practice Address - Street 1:1140 WESTMONT DR STE 425
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4358
Practice Address - Country:US
Practice Address - Phone:713-453-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942033163W00000X
TX1096487363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse