Provider Demographics
NPI:1619935210
Name:MESSERSCHMIDT, BONNIE L (NP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:MESSERSCHMIDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 FORT HENRY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:423-246-6445
Mailing Address - Fax:423-246-8240
Practice Address - Street 1:2995 FORT HENRY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:423-246-6445
Practice Address - Fax:423-246-8240
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0103OtherJOHN DEER HEALTH
TN3908262Medicaid
TN3908268Medicare ID - Type UnspecifiedPROVIDER NUMBER
TN3908262Medicaid