Provider Demographics
NPI:1083753230
Name:FREELAND, BONNIE LYN (APN-BC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYN
Last Name:FREELAND
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:4744 WHITE OAK DRIVE
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-1197
Mailing Address - Country:US
Mailing Address - Phone:423-240-7466
Mailing Address - Fax:
Practice Address - Street 1:5121 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:SUITE G
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8580
Practice Address - Country:US
Practice Address - Phone:423-238-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMF1220881OtherDEA
TNMF1220881OtherDEA