Jackie L Benson, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Vicksburg, MS
NPI 1366522997 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366522997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R124440 (MS)
- Practice address
- 2100 Highway 61 N
Vicksburg, MS 39183-8211 - Phone
- (601) 883-5000
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R124440 | MS | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vicksburg Clinic LLC | Past | Accepting new patients | |
| Vicksburg Clinic LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R124440 | MS | Yes |
Addresses
Primary practice location
2100 Highway 61 N
Vicksburg, MS 39183-8211
Mailing address
2100 Highway 61 N
Vicksburg, MS 39183-8211
Phone (601) 883-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00114410 | Medicaid | MS |
Other providers in Vicksburg, MS
- Jeremy Beavers
- Before & After Hair Salon, LLC
- Before & After Hair Salon, LLC
- Before & After Hair Salon, LLC
- Erin Sullivan Bennett
- Better Living Endoscopy Center
- Better Living Endoscopy Center
- Beyond Logistics LLC
- Nicole Bilbo
- Biometric Solutions
All providers in Vicksburg, MS · Certified Registered Nurse Anesthetist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.