Bonnie L Clark, WHNP-BC

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

CNP81695 Issued in ME

Practice address

5 Silver RDG
Veazie, ME 04401-7086

Phone

(207) 942-0824

Fax

(207) 942-0824

NPI assigned

Jan 15, 2007

Last updated

Jun 26, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mrs. Bonnie L.C. Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1063563310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SILVER RDG",
            "city": "VEAZIE",
            "state": "ME",
            "postal_code": "044017086",
            "telephone_number": "207-942-0824",
            "fax_number": "207-942-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SILVER RDG",
            "city": "VEAZIE",
            "state": "ME",
            "postal_code": "044017086",
            "telephone_number": "207-942-0824",
            "fax_number": "207-942-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BONNIE",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "WHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "ME",
            "license": "CNP81695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINE STATE BOARD OF NURSING",
            "identifier": "CNP81695",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINE STATE BOARD OF NURSING",
            "identifier": "RN18038",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "JACKSON",
            "middle_name": "L.C.",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Linda S. Allen, MSW
• Ryan Michael Bennett I, LMT
• Sandra Lucille Butters, M.A., CCC-SLP
• Alyssa Campbell, RN
• Kendall Fitzpatrick Doyle
• Kelly Fish
• Meagan Foss, LMSW-CC
• Jennifer Freese, D.O.
• Gerard Allan Graves, DC

• Women's Health Nurse Practitioner in Veazie, ME
• Providers in Veazie, ME by specialty
• Women's Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.