Provider Demographics
NPI:1427631167
Name:BENSON, NAHESSI LYLA (PA-C)
Entity type:Individual
Prefix:
First Name:NAHESSI
Middle Name:LYLA
Last Name:BENSON
Suffix:
Gender:F
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 1:43 RAINEY ST APT 1408
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4438
Mailing Address - Country:US
Mailing Address - Phone:956-465-8648
Mailing Address - Fax:
Practice Address - Street 1:7940 SHOAL CREEK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8059
Practice Address - Country:US
Practice Address - Phone:512-454-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant