Mark Bennett

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

10011034 Issued in OR

Practice address

777 Murphy Rd
Medford, OR 97504-8425

Phone

(541) 772-2763

Fax

(541) 734-3164

NPI assigned

Oct 22, 2025

Last updated

Oct 22, 2025By the provider in NPPES

Sex

Unspecified or another gender identity

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

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

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1730056961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 MURPHY RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048425",
            "telephone_number": "541-772-2763",
            "fax_number": "541-734-3164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 MURPHY RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048425",
            "telephone_number": "541-772-2763",
            "fax_number": "541-734-3164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-10-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "10011034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn Elizabeth Grace Bennett, CADC-R
• Brock Tanner Bennett, MD
• Erika Margaret Bennett, MD
• Katie Anne Bennett
• Kristen Bennett
• Natalie Marie Bennett, PHD
• Diana Marie Bennington
• Edwin Wridge Bennion, D.M.D.
• Charles Hamilton Benson Sr., MFT
• Darik Benson, M.D.

• Licensed Practical Nurse in Medford, OR
• Providers in Medford, OR by specialty
• Licensed Practical Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.