MEDICARE: KRISTINA BENTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1255192316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA BENTON

Provider Business Mailing Address
First Line	:	930 SOUTH AVE STE 4A
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-524-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SOUTH AVE STE 4A
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	908-797-2750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	07/03/2024

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Directions to “ KRISTINA BENTON ” Practice Location

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