Provider Demographics
NPI:1972583649
Name:BENJAMIN, ASHLI J (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLI
Middle Name:J
Last Name:BENJAMIN
Suffix:
Gender:
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:1640 E TALL TREE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2000
Practice Address - Country:US
Practice Address - Phone:316-274-8222
Practice Address - Fax:316-651-2344
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01056363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355040TMedicaid
003719191OtherMEDICARE
Q52524Medicare UPIN
KS200355040EMedicaid
Q52524Medicare UPIN