Basic Information
| Provider Information | |||||||||
| NPI: | 1629414354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTON | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3443 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725018820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706981635 | ||||||||
| FaxNumber: | 8707933196 | ||||||||
| Practice Location | |||||||||
| Address1: | 3443 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725018820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706981635 | ||||||||
| FaxNumber: | 8707933196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | A003822 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.