Healthcare Provider Details

I. General information

NPI: 1316764467
Provider Name (Legal Business Name): KAYLA MARIA BONILLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MEETING ST
LANCASTER SC
29720-2202
US

IV. Provider business mailing address

3794 BURNAGE HALL RD
HARRISBURG NC
28075-5608
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-1214
  • Fax:
Mailing address:
  • Phone: 704-787-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number29130
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8121
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: