Healthcare Provider Details

I. General information

NPI: 1588595227
Provider Name (Legal Business Name): KIRAH BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WALNUT ST
CHATTANOOGA TN
37402-1308
US

IV. Provider business mailing address

555 WALNUT ST
CHATTANOOGA TN
37402-1308
US

V. Phone/Fax

Practice location:
  • Phone: 423-553-5530
  • Fax:
Mailing address:
  • Phone: 423-553-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number138921981
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: