Provider Demographics
NPI:1386026557
Name:PATRICK, BONNIE RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:RENEE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-3534
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:55 TOWNSHIP ROAD 508 E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7276
Practice Address - Country:US
Practice Address - Phone:740-377-2712
Practice Address - Fax:740-377-2588
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009364363LF0000X
OH019848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136069Medicaid
KY7100354810Medicaid
WV3810029959Medicaid
KYK155081Medicare PIN
KY7100354810Medicaid