Individual provider · Type 1 NPI

Fred A. Benjamin IV, CRNA

Registered Nurse · Jackson, TN

NPI number 1063404036 Active

Practice location

36 Brentshire Sq
Jackson, TN 38305-2245

Call (731) 664-1717 Map

Fax (731) 664-7114

Mailing address

70 State Route 420
Humboldt, TN 38343-5619

Specialties and licenses

Taxonomy	Code	License
Registered Nurse Primary	163W00000X	RN0000085124 (TN)

Registered Nurse: (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient…

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About NPI 1063404036

Fred A. Benjamin IV, CRNA's National Provider Identifier is 1063404036, issued on Aug 16, 2005. The primary taxonomy on file is Registered Nurse (163W00000X), and the practice location is in Jackson, TN. The record was last updated on Jul 13, 2026.