Healthcare Provider Details

I. General information

NPI: 1689303679
Provider Name (Legal Business Name): STEPHANIE MICHELLE BENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BERKSHIRE RD
SMITHFIELD NC
27577-4751
US

IV. Provider business mailing address

910 BERKSHIRE RD
SMITHFIELD NC
27577-4751
US

V. Phone/Fax

Practice location:
  • Phone: 919-989-7909
  • Fax: 919-989-3147
Mailing address:
  • Phone: 919-989-7909
  • Fax: 919-989-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5016312
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016312
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5016312
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: