Healthcare Provider Details

I. General information

NPI: 1164399788
Provider Name (Legal Business Name): CAROL BENYOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRYAN AVE
NORTH PLATTE NE
69101-4370
US

IV. Provider business mailing address

501 N BRYAN AVE
NORTH PLATTE NE
69101-4370
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3965
  • Fax: 308-534-4311
Mailing address:
  • Phone: 308-532-3965
  • Fax: 308-534-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: