Individual
KIMBERLY CHRISTINE BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
180 N 5TH ST, PONCHATOULA, LA 70454-2532
(985) 370-7546
(985) 370-7765
Mailing address
180 N 5TH ST, PONCHATOULA, LA 70454-2532
(985) 370-7546
(985) 370-7765
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.200302
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1807311
—
LA
Enumeration date
10/07/2009
Last updated
08/28/2013
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