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General NPI Number Information
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NPI Number | 1265131031
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Entity Type | Individual
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Provider Name | KOURTNEY BENSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 102 TRIM MASTERS DRIVE
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439
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Country | US
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Telephone | 618-943-7900
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Fax | 618-943-7901
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Provider Business Mailing Address
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Address Line | 15930 ARIZONA RD
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-4700
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Country | US
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Telephone | 618-928-4531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 71013626A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.027097
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License Number State | IL
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