Provider Demographics
NPI:1467007708
Name:BONNIN, CHARLEY ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:ERIN
Last Name:BONNIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 KELLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-1967
Mailing Address - Country:US
Mailing Address - Phone:713-566-5100
Mailing Address - Fax:
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX881227OtherMEDICARE EMPLOYER PTAN - USP
TX881228OtherMEDICARE EMPLOYER PTAN - USA
TX8LX508OtherBCBS - XCITE SURGICAL LLC
TX8LX356OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX881228OtherMEDICARE EMPLOYER PTAN - USA
TX8LX355OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8LX429OtherBCBS - UNIVERSAL SURGICAL PARTNERS INC