Healthcare Provider Details

I. General information

NPI: 1629414354
Provider Name (Legal Business Name): JANICE ANN BENTON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

IV. Provider business mailing address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1635
  • Fax: 870-793-3196
Mailing address:
  • Phone: 870-698-1635
  • Fax: 870-793-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA003822
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: