Provider Demographics
NPI:1922347749
Name:BONOT, KRISTIE MICHELLE (PA - C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:BONOT
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 FOREST HILLS RD W STE B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3392
Mailing Address - Country:US
Mailing Address - Phone:252-991-0555
Mailing Address - Fax:
Practice Address - Street 1:2503 FOREST HILLS RD W STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3392
Practice Address - Country:US
Practice Address - Phone:252-991-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant