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NPI Code Detail

MEDICARE: BENJAMIN KEITH WINN PA-C

MEDICARE: BENJAMIN KEITH WINN 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 Assistant4746OK
2363A00000XPhysician Assistant1037AR
3363A00000XPhysician Assistant2025037891MO

General Provider Information

NPI Number : 1629736459
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN KEITH WINN PA-C
Provider Business Mailing Address
First Line : 109 N BROADWAY ST
Second Line :
City : SOUTH WEST CITY
State : MO
Zip : 64863-9417
Country : US
Telephone Number : 417-762-3287
Fax Number : 417-762-3255
Provider Business Practice Location Address
First Line : 109 N BROADWAY ST
Second Line :
City : SOUTH WEST CITY
State : MO
Zip : 64863-9417
Country : US
Telephone Number : 417-762-3287
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2021
Last Update Date : 11/12/2025

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