Jesse Bennion

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

7701604-3102 Issued in UT

Practice address

4473 W 13400 N
Cornish, UT 84308-1743

Phone

(435) 213-3123

NPI assigned

Mar 31, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Synergy Youth Treatment

  • Mental Illness Community Based Residential Treatment Facility
  • Cornish, UT
  • NPI 1366873440
  NPD (past)

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

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1508398207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4473 W 13400 N",
            "city": "CORNISH",
            "state": "UT",
            "postal_code": "843081743",
            "telephone_number": "435-213-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4473 W 13400 N",
            "city": "CORNISH",
            "state": "UT",
            "postal_code": "843081743",
            "telephone_number": "435-213-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNION",
        "first_name": "JESSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-31",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "7701604-3102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Cothran, LCSW
• Wendy Davies Foster, RN
• Allison Lemm
• Synergy Youth Treatment
• Benjamin Thomander

• All providers in Cornish, UT
• Registered Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; 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.