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General NPI Number Information
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NPI Number | 1891341392
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Entity Type | Individual
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Provider Name | BONNY WILLARD APRN
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 825 2ND AVE STE C2
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1791
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Country | US
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Telephone | 270-780-2750
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Fax | 270-780-2755
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Provider Business Mailing Address
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Address Line | PO BOX 2697
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City | BOWLING GREEN
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State | KY
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Zip | 42102-7697
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Country | US
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Telephone | 270-780-2750
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Fax | 270-780-2755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10180219
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License Number State | AL
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