Provider Demographics
NPI:1659327591
Name:STOCKTON, BONNIE CARDONA (ARNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:CARDONA
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S CREEK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9472
Mailing Address - Country:US
Mailing Address - Phone:606-348-3365
Mailing Address - Fax:606-348-8496
Practice Address - Street 1:1 S CREEK DR STE 102
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9472
Practice Address - Country:US
Practice Address - Phone:606-348-3365
Practice Address - Fax:606-348-8496
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610847215OtherCENTER CARE HEALTH BENE
KY610847215001OtherTRICARE
KY000000204626OtherANTHEM BC & BS
KY610847215OtherCHA HEALTH
KY000000061965OtherANTHEM BC & BS
KY78003878Medicaid
KY78003878Medicaid
KY000000061965OtherANTHEM BC & BS
KY000000204626OtherANTHEM BC & BS