Provider Demographics
NPI:1891341392
Name:WILLARD, BONNY (APRN)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BONNY
Other - Middle Name:
Other - Last Name:BRYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-780-2750
Mailing Address - Fax:270-780-2755
Practice Address - Street 1:825 2ND AVE STE C2
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1791
Practice Address - Country:US
Practice Address - Phone:270-780-2750
Practice Address - Fax:270-780-2755
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10180219363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology