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NPI Code Detail

MEDICARE: JENNIFER L BONAFEDE PA-C

MEDICARE: JENNIFER L BONAFEDE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA753KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
250052678OTHERKYPASSPORT

General Provider Information

NPI Number : 1154378289
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L BONAFEDE PA-C
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 6420 DUTCHMANS PKWY STE 200
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-3373
Country : US
Telephone Number : 502-891-8300
Fax Number : 502-891-8338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 04/07/2025

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