Provider Demographics
NPI:1104258011
Name:BENBOW, KYLER ELIZABETH (PA)
Entity type:Individual
Prefix:MS
First Name:KYLER
Middle Name:ELIZABETH
Last Name:BENBOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KYLER
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13430 N MERIDIAN ST STE 367
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1484
Mailing Address - Country:US
Mailing Address - Phone:317-575-2700
Mailing Address - Fax:317-575-2713
Practice Address - Street 1:13430 N MERIDIAN ST STE 367
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1484
Practice Address - Country:US
Practice Address - Phone:317-575-2700
Practice Address - Fax:317-575-2713
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN037170039Medicare PIN