Individual
TRACIE F BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
122 CENTER ST, CLAY, WV 25043-7046
(304) 587-7301
(304) 587-2464
Mailing address
122 CENTER ST, CLAY, WV 25043-7046
(304) 587-7301
(304) 587-2464
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
52119
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679709554
—
WV
01
—
52119
STATE NP LICENSE
WV
Enumeration date
06/05/2009
Last updated
09/04/2024
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