Provider Demographics
NPI:1407863103
Name:HELMS, BONITA G (CNM)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:G
Last Name:HELMS
Suffix:
Gender:F
Credentials:CNM
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 578
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0578
Mailing Address - Country:US
Mailing Address - Phone:334-677-5986
Mailing Address - Fax:334-677-4901
Practice Address - Street 1:1806 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3026
Practice Address - Country:US
Practice Address - Phone:334-677-5986
Practice Address - Fax:334-677-4901
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1022372367A00000X
AL1-022372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51095624OtherBLUE CROSS
AL569900131Medicaid
R44818Medicare UPIN