Individual provider Active NPI

Karen Anne Paulosky-Benton, RN

  • Registered Nurse
  • Traverse City, MI
National Provider Identifier
1124641758
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
4704139056 Issued in MI
Practice address
626 E Eighth St Ste 17
Traverse City, MI 49686-2504
Phone
(231) 590-9758
NPI assigned
May 18, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704139056 MI Primary

Addresses

Primary practice location

626 E Eighth St Ste 17
Traverse City, MI 49686-2504

Mailing address

9702 Bluff TRL
Williamsburg, MI 49690-9507
Phone (231) 590-9758

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704139056MIMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1124641758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9702 BLUFF TRL",
            "city": "WILLIAMSBURG",
            "state": "MI",
            "postal_code": "496909507",
            "telephone_number": "231-590-9758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 E EIGHTH ST STE 17",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496862504",
            "telephone_number": "231-590-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULOSKY-BENTON",
        "first_name": "KAREN",
        "middle_name": "ANNE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-18",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704139056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.