# BENTON FAMILY MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811129745
- **Authorized official:** MS. KELLEY NOVAK (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (318) 965-1000

## Contact information

- **Practice address:** 188 BURT BLVD, BENTON, LA 71006-4900
- **Practice address phone:** (318) 965-1000
- **Mailing address:** 188 BURT BLVD, BENTON, LA 71006-4900
- **Mailing address phone:** (318) 965-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD09509R | LA | Yes |
| 363LF0000X | Family Nurse Practitioner | AP04759 | LA | — |

## Other

- **Enumeration date:** 08/11/2009
- **Last updated:** 08/11/2009