Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | A006084 | AR |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A006084 | AR |
NPI | 1003389834 |
---|---|
Provider Name | Ashley Benton |
First Address | North Little Rock, AR 72116-7253 |
Second Address | Dallas, TX 75244-5071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MB5253214 | DEA (01) | AR |