Organization
BENTON FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLEY NOVAK (PHYSICIAN ASSISTANT)
(318) 965-1000
Entity
Organization
Contact information
Practice address
188 BURT BLVD, BENTON, LA 71006-4900
(318) 965-1000
Mailing address
188 BURT BLVD, BENTON, LA 71006-4900
(318) 965-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD09509R
LA
363LF0000X
Family Nurse Practitioner
AP04759
LA
Other
Enumeration date
08/11/2009
Last updated
08/11/2009
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