Healthcare Provider Details

I. General information

NPI: 1982538088
Provider Name (Legal Business Name): FARRAH BONNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N CAPITAL ST
SUFFOLK VA
23434-3420
US

IV. Provider business mailing address

306 N CAPITAL ST
SUFFOLK VA
23434-3420
US

V. Phone/Fax

Practice location:
  • Phone: 470-290-9935
  • Fax:
Mailing address:
  • Phone: 470-290-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: