Provider Demographics
NPI:1003213059
Name:BENSON, JENNIFER BLAIR GARRETT (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BLAIR GARRETT
Last Name:BENSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29343
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2045
Mailing Address - Country:US
Mailing Address - Phone:903-232-8290
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:709 HOLLYBROOK DR STE 4500
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2412
Practice Address - Country:US
Practice Address - Phone:903-291-6287
Practice Address - Fax:903-291-6286
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52761363AM0700X
TXPATEMP363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical