Healthcare Provider Details

I. General information

NPI: 1316596240
Provider Name (Legal Business Name): AMY ELIZABETH BENCHINA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 WHITEHALL PARK DR STE 300
CHARLOTTE NC
28273-4179
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 980-302-8850
  • Fax: 704-316-8118
Mailing address:
  • Phone: 704-384-9414
  • Fax: 704-384-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5012211
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5012211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: