Provider Demographics
NPI:1467931949
Name:BONNETT, KELLY M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:BONNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 20TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3832
Mailing Address - Country:US
Mailing Address - Phone:205-333-5900
Mailing Address - Fax:
Practice Address - Street 1:2701 20TH AVENUE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3832
Practice Address - Country:US
Practice Address - Phone:205-333-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138625363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics