NPIMap

Jessica Mackenzie Benjes, CRNP

Individual provider Active NPI Pediatric Nurse Practitioner · Nottingham, MD

NPI 1760298665 · NPPES record last updated Dec 5, 2024

Key facts

NPI
1760298665
Entity type
Individual (NPI type 1)
Primary specialty
Pediatric Nurse Practitioner 363LP0200X
License
R233684 (MD)
Practice address
8114 Sandpiper Cir Ste 100
Nottingham, MD 21236-5901
Phone
(410) 933-8101
NPI assigned
Dec 5, 2024
Sex
Female
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R233684MDMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Honeygo Pediatrics Past
since Dec 8, 2024		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R233684 MD Yes

Addresses

Primary practice location

8114 Sandpiper Cir Ste 100
Nottingham, MD 21236-5901

Mailing address

13 Bright Star CT
Baltimore, MD 21206-2269
Phone (717) 824-6142

Other providers in Nottingham, MD

All providers in Nottingham, MD · Pediatric Nurse Practitioner in Maryland

Sources for this page

Verify at the official NPI Registry.