Individual
JENNIFER L BONAFEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6420 DUTCHMANS PKWY STE 200, LOUISVILLE, KY 40205-3373
(502) 891-8300
(502) 891-8338
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA753
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50052678
PASSPORT
KY
05
—
95003091
—
KY
Enumeration date
05/26/2006
Last updated
04/07/2025
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