Provider Demographics
NPI:1083254320
Name:BONAR, KATIE JANE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JANE
Last Name:BONAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 7TH ST SE STE 140
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3394
Mailing Address - Country:US
Mailing Address - Phone:256-973-5400
Mailing Address - Fax:
Practice Address - Street 1:1215 7TH ST SE STE 140
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3394
Practice Address - Country:US
Practice Address - Phone:256-973-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine