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NPI Code Detail

MEDICARE: KATIE BENNION PA-C

MEDICARE: KATIE BENNION PA-C
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
1363A00000XPhysician AssistantPA.0007965CO

General Provider Information

NPI Number : 1619231867
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE BENNION PA-C
Provider Business Mailing Address
First Line : 988102 NEBRASKA MEDICAL CTR
Second Line :
City : OMAHA
State : NE
Zip : 68198-8102
Country : US
Telephone Number : 402-559-6195
Fax Number :
Provider Business Practice Location Address
First Line : 722 S WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4035
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 06/19/2024

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Directions to “ KATIE BENNION PA-C” Practice Location

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