Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Laurren Ashley Bennett, PA-C

Individual provider Physician Assistant · NPI 1104419431

Laurren Ashley Bennett, PA-C is a Physician Assistant in Idaho Falls, Idaho. Qualified in 2020, 6 years ago. Practices with Tony C Roisum MD PA, a 5-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
6
Licensed in
ID
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

740 S Woodruff Ave
Idaho Falls, ID 83401-5285
Phone: (209) 542-9111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2020 (ID)

Record details

NPI number1104419431
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 17, 2021
Last updated in NPPESFebruary 17, 2021
Certification dateFebruary 17, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Tony C Roisum Md Pa — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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