# MRS. MADONNA KAY BONNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1841271897
- **Gender:** F
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 00400 | WV | Yes |

## Other

- **Enumeration date:** 11/08/2005
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001804181 | MTN STATE BC/BS PAY TO 1 | WV |
| 01 | — | 001837930 | MTN STATE SERVICE NUMBER | WV |
| 01 | — | 001967359 | MTN STATE BC/BS PAY TO 2 | WV |
| 01 | — | 00400 | WVBOM PA-C LICENSE | WV |
| 01 | — | 1023337 | NCCPA | WV |
| 01 | — | 3000318 | BRICKSTREET WORKERS COMP | WV |
| 05 | — | 3810005145 | — | WV |
| 01 | — | 734619 | NCPPO PROVIDER | WV |
| 01 | — | FQ400 | HEALTH PLAN PROVIDER NO. | WV |
| 01 | — | P00328118 | RAILROAD MEDICARE | WV |
| 01 | — | WV400 | HEALTH PLAN | WV |