Individual
JASON KRISTOPHER BODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
140 KIMEL PARK DR, WINSTON SALEM, NC 27103-6160
(336) 245-2100
(336) 768-7782
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 245-2100
(336) 768-7782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04142
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8103258
—
NC
Enumeration date
07/26/2006
Last updated
03/06/2017
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