Basic Information
| Provider Information | |||||||||
| NPI: | 1962063362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | LEVI | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1408 EAST ST | ||||||||
| Address2: | |||||||||
| City: | IOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667494402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203634748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1408 EAST ST | ||||||||
| Address2: | |||||||||
| City: | IOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667494402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203653115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-78768-051 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.