Provider Demographics
NPI:1225820541
Name:BENNER, KYM KAYE (DOULA)
Entity type:Individual
Prefix:MRS
First Name:KYM
Middle Name:KAYE
Last Name:BENNER
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N EL CAMINO REAL SPC 406
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1797
Mailing Address - Country:US
Mailing Address - Phone:951-218-5490
Mailing Address - Fax:
Practice Address - Street 1:200 N EL CAMINO REAL SPC 406
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1797
Practice Address - Country:US
Practice Address - Phone:951-218-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula