Provider Demographics
NPI:1043976160
Name:BENTON, MICHELLE ALLYN CLAYTON (NP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ALLYN CLAYTON
Last Name:BENTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HALEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4856
Mailing Address - Country:US
Mailing Address - Phone:864-230-0721
Mailing Address - Fax:
Practice Address - Street 1:8 HALEHAVEN DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4856
Practice Address - Country:US
Practice Address - Phone:864-230-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner