Bonnie Beth Wickham, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04799 Issued in TX

Practice address

12039 E Maple Springs Way
Palmer, AK 99645-9797

Phone

(907) 745-9088

Fax

(833) 464-5211

NPI assigned

Jul 19, 2006

Last updated

Aug 12, 2026By 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

Enrolled in TX, AK, OR3 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Network of Alaska LLCGroup PAC ID 3072618859, 70 clinicians

St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
• St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bwickham8673@shannonhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Charles Health System, Inc.

  dba St. Charles Medical Group

  • Family Medicine Physician
  • Bend, OR
  • NPI 1023331303
  Medicare reassignment Care Compare group NPD
• Medical Network of Alaska, LLC

  dba Capstone Urgent Care

  • Urgent Care Clinic/Center
  • Wasilla, AK
  • NPI 1538414834
  Medicare reassignment Care Compare group
• Alaska Medical Clinics, LLC

  dba Wasilla Medical Clinic

  • Urgent Care Clinic/Center
  • Wasilla, AK
  • NPI 1316015480
  Medicare reassignment
• Alaska Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Anchorage, AK
  • NPI 1518389303
  Medicare reassignment
• St. Charles Health System, Inc.

  dba The Center at St. Charles Medical Equipment

  • Specialist
  • Bend, OR
  • NPI 1700697935
  NPD
• Medical Network of Alaska, LLC

  dba Resound ENT

  • Otolaryngology Physician
  • Anchorage, AK
  • NPI 1922862986
  NPD (past)
• Jumano Emergency Physicians

  • Emergency Medicine Physician
  • San Angelo, TX
  • NPI 1619231511

  Physician Assistant

  NPD (past)
• Oasis of West TX Emergency

  • Emergency Medicine Physician
  • San Angelo, TX
  • NPI 1457606154

  Physician Assistant

  NPD (past)
• St. Charles Health System, Inc.

  dba St. Charles Medical Supply - Redmond

  • Oxygen Equipment & Supplies (DME)
  • Redmond, OR
  • NPI 1427140870
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cascade Healthcare Community Inc

  dba NW High Desert Sleep Center Bend

  • Sleep Disorder Diagnostic Clinic/Center
  • Bend, OR
  • NPI 1164675963

  Hospital

  Care Compare affiliation
• St. Charles Health System, Inc.

  dba St. Charles Prineville

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  Care Compare affiliation
• St. Charles Health System, Inc.

  dba St. Charles Bend

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Care Compare affiliation

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1225058902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12039 E MAPLE SPRINGS WAY",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996459797",
            "telephone_number": "907-745-9088",
            "fax_number": "833-464-5211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "402 W 26th St",
            "address_purpose": "LOCATION",
            "city": "San Angelo",
            "state": "TX",
            "postal_code": "769032826",
            "country_code": "US",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "61250 SE Coombs Pl",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977023704",
            "country_code": "US",
            "telephone_number": "541-706-5930",
            "fax_number": "541-706-5931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "BONNIE",
        "middle_name": "BETH",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel S West
• Mary Beth Westland
• Rachel Marie White
• Sarah White
• Adam Charles Whitehead, LMT
• Wild Iris Integrative Massage LLC
• Hal Bret Willardson, MD
• Emily Williams
• Jordyn Nicole Williams
• Kathryn Williams, R.N

• Physician Assistant in Palmer, AK
• Providers in Palmer, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.