Healthcare Provider Details

I. General information

NPI: 1174016539
Provider Name (Legal Business Name): EMILY BENGSTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 N COUNTY ROAD 25A STE 104
TROY OH
45373-1373
US

IV. Provider business mailing address

3600 FM 2181 STE 100
HICKORY CREEK TX
75065-7636
US

V. Phone/Fax

Practice location:
  • Phone: 937-335-3518
  • Fax: 937-332-6857
Mailing address:
  • Phone: 940-498-4422
  • Fax: 940-321-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: