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NPI Code Detail

MEDICARE: JORDAN BENNER

MEDICARE: JORDAN BENNER
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNC

General Provider Information

NPI Number : 1700728532
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN BENNER
Provider Business Mailing Address
First Line : 607 BEAMAN ST
Second Line :
City : CLINTON
State : NC
Zip : 28328-2603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 607 BEAMAN ST
Second Line :
City : CLINTON
State : NC
Zip : 28328-2603
Country : US
Telephone Number : 910-592-8511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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Directions to “ JORDAN BENNER ” Practice Location

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