Provider Demographics
NPI:1871663419
Name:CONLEY, BONITA WILLIAMS (RN, PNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:WILLIAMS
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RN, PNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1321 HEATHER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2761
Mailing Address - Country:US
Mailing Address - Phone:972-396-9196
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:A3.03
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-5415
Practice Address - Fax:215-456-8469
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647518363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics