Provider Demographics
NPI:1043588734
Name:HARMON, BENJAMIN WADE (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WADE
Last Name:HARMON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2489
Mailing Address - Country:US
Mailing Address - Phone:931-372-0405
Mailing Address - Fax:
Practice Address - Street 1:142 W 5TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1760
Practice Address - Country:US
Practice Address - Phone:931-783-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner