Provider Demographics
NPI:1174304109
Name:BENNY, JENCY
Entity type:Individual
Prefix:
First Name:JENCY
Middle Name:
Last Name:BENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10882 PRITCHARD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7392
Mailing Address - Country:US
Mailing Address - Phone:254-239-8995
Mailing Address - Fax:
Practice Address - Street 1:10882 PRITCHARD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7392
Practice Address - Country:US
Practice Address - Phone:254-239-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138145363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care