Provider Demographics
NPI:1528895299
Name:BENTON, JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:AR
Mailing Address - Zip Code:72111-9090
Mailing Address - Country:US
Mailing Address - Phone:501-912-9442
Mailing Address - Fax:
Practice Address - Street 1:2794 S 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7020
Practice Address - Country:US
Practice Address - Phone:501-288-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine