Provider Demographics
NPI:1730425281
Name:COLVIN, BENJAMIN JAMES (RN)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JAMES
Last Name:COLVIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COMMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4403
Mailing Address - Country:US
Mailing Address - Phone:318-663-4914
Mailing Address - Fax:
Practice Address - Street 1:641 ROWENA ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:LA
Practice Address - Zip Code:71454-6313
Practice Address - Country:US
Practice Address - Phone:318-646-3000
Practice Address - Fax:318-646-3003
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120031163W00000X
LAAP07366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse