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Individual

MRS. BONNIE LYNN BLACKBURN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
10 AMALIA DR STE C5, BUCKHANNON, WV 26201-2270
(304) 460-7948
(304) 460-7908
Mailing address
1 AMALIA DR, BUCKHANNON, WV 26201-2239
(304) 473-2000

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2411
WV
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/15/2020
Last updated
09/15/2020
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