Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP140896 | TX |
NPI | 1013478320 |
---|---|
Provider Name | John Robert Benson |
First Address | Austin, TX 78704-2911 |
Second Address | Austin, TX 78753-4808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2019 |
Last Update Date | 28/03/2019 |