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General NPI Number Information
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NPI Number | 1023111929
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Entity Type | Organization
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Legal Business Name | BENTON HEALTH CARE, LLC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 414 EAST 12TH STREET
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City | BENTON
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State | KY
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Zip | 42025
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Country | US
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Telephone | 270-527-3900
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Fax | 270-527-3901
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Provider Business Mailing Address
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Address Line | PO BOX 9150
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City | PADUCAH
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State | KY
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Zip | 42002-9150
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Country | US
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Telephone | 270-744-9600
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Fax | 270-744-0834
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. JASON FIESSINGER
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Credential | APRN
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Telephone | 270-527-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | KY 3122P
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License Number State | KY
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