Provider Demographics
NPI:1942409263
Name:BONNEY, LATOYA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:MICHELLE
Last Name:BONNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:548 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2604
Mailing Address - Country:US
Mailing Address - Phone:540-586-4723
Mailing Address - Fax:540-586-5269
Practice Address - Street 1:548 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523
Practice Address - Country:US
Practice Address - Phone:540-586-4723
Practice Address - Fax:540-586-5269
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant