Individual provider Active NPI

Kristie Dawn Bonnett, N.P

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1669401337
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5001437 Issued in NC
Practice address
1950 S Hawthorne Rd
Winston Salem, NC 27103-3912
Phone
(336) 718-8386
Fax
(336) 718-0290
NPI assigned
Jul 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 005001437 NC
Nurse Practitioner 363L00000X 5001437 NC Primary

Addresses

Primary practice location

1950 S Hawthorne Rd
Winston Salem, NC 27103-3912

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 718-7080

Other identifiers 2

IdentifierTypeStateIssuer
0050 01437OtherNCMEDICAL BOARD LICENSE
2005010216OtherFLCERTIFICATION

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbonnett39541@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20060823000382 NC Practitioner - Nurse Practitioner 7618970195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1010 Bethesda CT
Winston Salem, NC 27103-3019
Phone (336) 277-6000

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
01437NCMDMarriage & Family Therapist
5001437NCMDNurse Practitioner
005001437NCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group Inc CurrentSince May 1, 2016 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 1, 2016 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

390 W Salem Ave
Winston Salem, NC 27101
Phone (336) 721-2375

1010 Bethesda Ct
Winston Salem, NC 27103
Phone (336) 277-6000

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: kbonnett39541@direct.novanthealth.org

Organizations & group practices 4

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

Hospital & facility affiliations 2

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1669401337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-718-7080",
            "fax_number": "336-718-9622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033912",
            "telephone_number": "336-718-8386",
            "fax_number": "336-718-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNETT",
        "first_name": "KRISTIE",
        "middle_name": "DAWN",
        "credential": "N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "005001437",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5001437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD LICENSE",
            "identifier": "0050 01437",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "2005010216",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbonnett39541@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1950 S Hawthorne Rd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271033912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.