Healthcare Provider Details

I. General information

NPI: 1669069084
Provider Name (Legal Business Name): ELISABETH MARY BENHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH CAMPBELL NP

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 395
LEXINGTON NC
27293-0395
US

IV. Provider business mailing address

PO BOX 395
LEXINGTON NC
27293-0395
US

V. Phone/Fax

Practice location:
  • Phone: 336-347-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: