Healthcare Provider Details

I. General information

NPI: 1679394217
Provider Name (Legal Business Name): JENNIFER LEE BENITES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3543
US

IV. Provider business mailing address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3504
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6371
  • Fax: 859-257-3585
Mailing address:
  • Phone: 859-948-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4023956
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: