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General NPI Number Information
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NPI Number | 1770672339
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Entity Type | Organization
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Legal Business Name | AMY BENJAMIN
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 618 CR 5031
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City | BOONEVILLE
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State | MS
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Zip | 38829
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Country | US
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Telephone | 662-365-0200
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Fax | 662-365-0199
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | WHEELER
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State | MS
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Zip | 38880-0095
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Country | US
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Telephone | 662-365-0200
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Fax | 662-365-0199
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIE TYUS
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Credential | OFFICE MANAGER
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Telephone | 662-365-0200
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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 | R850588
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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