=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124786538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL LEIGH BENTON PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2021
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7030 S YOSEMITE ST
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-721-9984
-----------------------------------------------------
Fax | 303-267-7304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7030 S YOSEMITE ST
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-721-9984
-----------------------------------------------------
Fax | 303-267-7304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA.0007043
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------