Healthcare Provider Details

I. General information

NPI: 1285018192
Provider Name (Legal Business Name): KERRI DAWN BENNING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAIN STREET
TURTLE LAKE ND
58575
US

IV. Provider business mailing address

PO BOX 535
TURTLE LAKE ND
58575-0535
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-9244
  • Fax: 701-448-2056
Mailing address:
  • Phone: 701-448-9244
  • Fax: 701-448-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR31077
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: