Provider Demographics
NPI:1144398330
Name:SMITH, BONNIE JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 3 BOX 244
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2600
Mailing Address - Country:US
Mailing Address - Phone:304-472-8970
Mailing Address - Fax:
Practice Address - Street 1:59 COLLEGE AVENUE
Practice Address - Street 2:BARNHART MEMORIAL STUDENT HEALTH CENTER WEST VIRGINIA W
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2600
Practice Address - Country:US
Practice Address - Phone:304-473-8100
Practice Address - Fax:304-473-8200
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22343363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool