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General NPI Number Information
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NPI Number | 1750931655
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Entity Type | Organization
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Legal Business Name | BONNER MEDICAL AND BEHAVIORAL HEALTH SPECIALISTS, PLLC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1288 MILL CREEK CV
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City | MEMPHIS
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State | TN
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Zip | 38134-7820
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Country | US
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Telephone | 865-246-2104
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Fax | 865-246-2106
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Provider Business Mailing Address
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Address Line | PO BOX 5777
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City | MARYVILLE
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State | TN
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Zip | 37802-5777
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Country | US
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Telephone | 865-246-2104
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Fax | 865-246-2106
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Authorized Official
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Title or Position | OWNER
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Name | CHARLENE BONNER
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Credential | FNP
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Telephone | 865-246-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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