Healthcare Provider Details

I. General information

NPI: 1114128725
Provider Name (Legal Business Name): KEILAH ISABEL GONZALEZ-BONILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9546 S NORTHSHORE DR
KNOXVILLE TN
37922-5813
US

IV. Provider business mailing address

9546 S NORTHSHORE DR
KNOXVILLE TN
37922-5813
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3440
  • Fax: 865-647-2683
Mailing address:
  • Phone: 865-647-3440
  • Fax: 865-647-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME96511
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number45347
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number45347
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45347
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: