Healthcare Provider Details

I. General information

NPI: 1093639015
Provider Name (Legal Business Name): COURTNEY ANN BOHNERT PA-C, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-4914
US

IV. Provider business mailing address

2005 PERRYVILLE RD
CAPE GIRARDEAU MO
63701-2484
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-5544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2022016526
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026046134
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: