Provider Demographics
NPI:1215905617
Name:BENISH, RANDY E (PA-C)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:E
Last Name:BENISH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 CALL FIELD RD STE E
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2679
Mailing Address - Country:US
Mailing Address - Phone:940-264-2625
Mailing Address - Fax:940-264-6401
Practice Address - Street 1:4007 CALL FIELD RD STE E
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2679
Practice Address - Country:US
Practice Address - Phone:940-264-2625
Practice Address - Fax:940-264-6401
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS10774OtherUPIN