Healthcare Provider Details

I. General information

NPI: 1407742521
Provider Name (Legal Business Name): NATALIE BROOKE BENSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE LEAKE RN

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FAIRY STREET EXT STE A
MARTINSVILLE VA
24112-1913
US

IV. Provider business mailing address

1425 WEBBS MILL RD N
FLOYD VA
24091-3591
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-5437
  • Fax: 276-666-6686
Mailing address:
  • Phone: 540-271-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024193765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: