Healthcare Provider Details

I. General information

NPI: 1720691421
Provider Name (Legal Business Name): MEGHAN BENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E EGBERT ST
BRIGHTON CO
80601-2404
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-2583
  • Fax:
Mailing address:
  • Phone: 303-697-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006330
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: