Provider Demographics
NPI:1104605351
Name:BENTON, MAKENNA K (NP)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:K
Last Name:BENTON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:K
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-0920
Practice Address - Fax:317-968-1165
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28264344A163W00000X
IN71015628A363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300095530Medicaid
IN266431087OtherMEDICARE PTAN