Individual
MRS. MADONNA KAY BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
720 BEVERLY PIKE, ELKINS, WV 26241-9205
(304) 636-4585
(304) 637-4588
Mailing address
720 BEVERLY PIKE, ELKINS, WV 26241-9205
(304) 636-4585
(304) 637-4588
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00400
WV
Other
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
Enumeration date
11/08/2005
Last updated
03/07/2023
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