Bonita Lois Martin, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

123723 Issued in AR

Practice address

500 E Collin Raye Dr
De Queen, AR 71832-8048

Phone

(870) 584-1055

NPI assigned

Jan 6, 2020

Last updated

Feb 11, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1053950113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 BRIDGE CREEK RD",
            "city": "HORATIO",
            "state": "AR",
            "postal_code": "718429000",
            "telephone_number": "870-784-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718328048",
            "telephone_number": "870-584-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "BONITA",
        "middle_name": "LOIS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-06",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "123723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Logan, P. D.
• Mark R. Stewart, DMD, Inc.
• Maddison Grace Marshall
• Martin Family Medical Clinic PLLC
• Angela Kay Martin, APRN
• Kimberly Ann Martin, MS, OTR/L
• Marlen Martinez
• Suguey Martinez, RDH
• Nickolas Matthews, APRN-CNP
• Susan Kathryn McClintock, APRN

• Gerontology Nurse Practitioner in De Queen, AR
• Providers in De Queen, AR by specialty
• Gerontology Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.