MEDICARE: KATHRYN COPELAND BENET

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	:	1306316054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN COPELAND BENET

Provider Business Mailing Address
First Line	:	2020 W ST HWY 114 STE 310
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-8650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W ST HWY 114 STE 310
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-8650
Country	:	US
Telephone Number	:	214-619-1910
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	01/07/2025

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Directions to “ KATHRYN COPELAND BENET ” Practice Location

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