Healthcare Provider Details

I. General information

NPI: 1467213090
Provider Name (Legal Business Name): KELSEY MICHELLE BENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 22ND AVE E
SPRINGFIELD TN
37172-3711
US

IV. Provider business mailing address

426 22ND AVE E
SPRINGFIELD TN
37172-3711
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-0600
  • Fax: 615-384-3118
Mailing address:
  • Phone: 615-384-0600
  • Fax: 615-384-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1154855
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: