Healthcare Provider Details

I. General information

NPI: 1245900398
Provider Name (Legal Business Name): CHRIS ALLEN BENGE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 N MAIN ST
MIAMI OK
74354-1602
US

IV. Provider business mailing address

1717 S RANGE LINE RD STE B
JOPLIN MO
64804-3224
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-9077
  • Fax:
Mailing address:
  • Phone: 417-623-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227968
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021037375
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: