Individual provider Active NPI

Kaileigh Bonno, FNP-C

  • Family Nurse Practitioner
  • Canton, NY
National Provider Identifier
1629813829
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
354265 Issued in NY
Practice address
39 W Main St
Canton, NY 13617-1358
Phone
(315) 379-4700
Fax
(315) 713-6512
NPI assigned
Jun 28, 2024
Last updated
Jun 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 354265 NY Primary

Addresses

Primary practice location

39 W Main St
Canton, NY 13617-1358

Mailing address

39 W Main St
Canton, NY 13617-1358
Phone (315) 379-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240820003402 NY Practitioner - Nurse Practitioner 6507304664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carthage Area Hospital IncGroup PAC ID 9931010485, 119 clinicians
Claxton-Hepburn Medical CenterGroup PAC ID 8426966508, 78 clinicians

Practice addresses (Care Compare)

1001 W St
Carthage, NY 13619-9703
Phone (315) 493-1000

117 N Mechanic St
Carthage, NY 13619-1252
Phone (315) 493-4187

214 King St
Ogdensburg, NY 13669-1142
Phone (315) 393-3600

3 Bridge St
Carthage, NY 13619-1353

3 Bridge St
Carthage, NY 13619-1360
Phone (315) 493-0110

39 W Main St
Canton, NY 13617-1358
Phone (315) 379-4700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
354265NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carthage Area Hospital Inc CurrentSince Jul 22, 2024 Accepting new patients
Carthage Area Hospital Inc Current Accepting new patients
Carthage Area Hospital Inc CurrentSince Jul 22, 2024 Accepting new patients
Carthage Area Hospital Inc. Past Accepting new patients

Locations

39 W Main St
Canton, NY 13617
Phone (315) 379-4700

1001 West St
Carthage, NY 13619
Phone (315) 493-1000

Interoperability endpoints

  • Direct secure messaging: kbonno@cahclinics.medentdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1629813829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 W MAIN ST",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171358",
            "telephone_number": "315-379-4700",
            "fax_number": "315-713-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 W MAIN ST",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171358",
            "telephone_number": "315-379-4700",
            "fax_number": "315-713-6512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNO",
        "first_name": "KAILEIGH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, NY

Sources for this page

Verify at the official NPI Registry.