Provider Demographics
NPI:1609962620
Name:ENNEKING, BONNIE J (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:ENNEKING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:J
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 W MAIN ST
Mailing Address - Street 2:P.O. BOX 6
Mailing Address - City:HIGHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66035-4143
Mailing Address - Country:US
Mailing Address - Phone:785-442-3213
Mailing Address - Fax:785-442-5572
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:KS
Practice Address - Zip Code:66035-4143
Practice Address - Country:US
Practice Address - Phone:785-442-3213
Practice Address - Fax:785-442-5572
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44118363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100417990AMedicaid
KS160278Medicare ID - Type Unspecified