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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

FRED A BENJAMIN IV CRNA
NPI 1063404036
Registered Nurse in Jackson, TN

Active since August 16, 2005
36 BRENTSHIRE SQ, JACKSON, TN 38305(731) 664-1717(731) 664-7114 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Fred A Benjamin Iv Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FRED A BENJAMIN IV CRNA (NPI 1063404036) is an individual registered nurse in Jackson, Tennessee, licensed in Tennessee (RN0000085124) and active in the NPI registry since August 2005.

NPPES Registry Identity

NPI1063404036
Entity TypeIndividualMale
Primary Taxonomy163W00000X
Provider Legal NameFRED A BENJAMIN IVCredential: CRNA
Location Address36 BRENTSHIRE SQJackson, TN 38305-2245
Mailing Address70 State Route 420Humboldt, TN 38343-5619 · (731) 824-1939
Phone(731) 664-1717
Fax(731) 664-7114
Sole ProprietorNo
Enumeration DateAugust 16, 2005
Last NPPES UpdateJuly 13, 2026
✔ NPI 1063404036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered NurseNursing Service Providers
Taxonomy Code163W00000X
License✔ Licensed in TN · RN0000085124
Definition
(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 in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.
36 BRENTSHIRE SQ, Jackson, TN 38305
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Other Identifiers 1

Medicaid3622768TN

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN W TURNER CRNA
Registered Nurse
36 BRENTSHIRE SQ
JACKSON, TN 38305
Madison County (731) 664-1717
SEC CONSULTING FIRM, PLLC
Community/Behavioral Health
36 BRENTSHIRE SQ, SUITE A
JACKSON, TN 38305
Madison County (731) 736-2211
DELANA E POTTER CRNA
Nurse Anesthetist, Certified Registered
36 BRENTSHIRE SQ
JACKSON, TN 38305
Madison County (731) 664-1717

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fred Benjamin Iv's NPI number?

The NPI number for Fred Benjamin Iv is 1063404036. It was assigned to this individual provider in the NPPES registry on August 16, 2005.

Where is Fred Benjamin Iv located?

Fred Benjamin Iv practices at 36 Brentshire Sq, Jackson, TN 38305. The listed phone number is (731) 664-1717.

What is Fred Benjamin Iv's specialty?

The primary specialty registered for this NPI is Registered Nurse with taxonomy code 163W00000X.

When was this NPI record last updated?

The NPPES record for Fred Benjamin Iv was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 48 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.