Provider Demographics
NPI:1124538368
Name:BONNETTE, MADELINE TAYLOR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:TAYLOR
Last Name:BONNETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:MACKENZI
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3802 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3731
Mailing Address - Country:US
Mailing Address - Phone:318-487-6060
Mailing Address - Fax:318-487-0406
Practice Address - Street 1:3802 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3731
Practice Address - Country:US
Practice Address - Phone:318-487-6060
Practice Address - Fax:318-487-0406
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant