Provider Demographics
NPI:1104000553
Name:BENISH, KIMBERLY ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BENISH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SCHOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5905
Mailing Address - Country:US
Mailing Address - Phone:870-361-1935
Mailing Address - Fax:870-361-1940
Practice Address - Street 1:301 E BROAD ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5905
Practice Address - Country:US
Practice Address - Phone:870-361-1935
Practice Address - Fax:870-361-1940
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1826363LF0000X
AZ303049363LF0000X
NV871908163WG0000X, 363LF0000X
FLAPRN11029646363LF0000X
IAA177118363LF0000X
KS53-82847-082363LF0000X
MECNP231599363LF0000X
MTAPRN-230368363LF0000X
NM76374363LF0000X
NDR55245363LF0000X
VT101.0136697363LF0000X
WAAP61503102363LF0000X
NE115070363LF0000X
ARA003590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice