Provider Demographics
NPI:1720555097
Name:BONN, DEREK C (NP)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:C
Last Name:BONN
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:16107 KENSINGTON DR STE 126
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4224
Mailing Address - Country:US
Mailing Address - Phone:281-336-0552
Mailing Address - Fax:281-336-0552
Practice Address - Street 1:2560 E LEAGUE CITY PKWY
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6459
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:713-439-7995
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2021-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP139481363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily