Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024181457 | VA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024181457 | VA |
NPI | 1083382717 |
---|---|
Provider Name | Scott Kenneth Benson |
First Address | Atlanta, GA 30384-2924 |
Second Address | North Chesterfield, VA 23236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 28/10/2021 |