MEDICARE: TRACY LEE BENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	770530	TX

General Provider Information

NPI Number	:	1326481953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEE BENSON

Provider Business Mailing Address
First Line	:	5737 CULLEN BLVD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-1665
Country	:	US
Telephone Number	:	713-440-7313
Fax Number	:	713-440-8358

Provider Business Practice Location Address
First Line	:	5737 CULLEN BLVD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-1665
Country	:	US
Telephone Number	:	713-440-7313
Fax Number	:	713-440-8358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2013
Last Update Date	:	04/16/2019

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Directions to “ TRACY LEE BENSON ” Practice Location

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