Tracie F Bonner, FNP
Individual provider Active NPI Family Nurse Practitioner · Clay, WV
NPI 1679709554 · NPPES record last updated Sep 4, 2024
Key facts
- NPI
- 1679709554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 52119 (WV)
- Practice address
- 122 Center St
Clay, WV 25043-7046 - Phone
- (304) 587-7301
- Fax
- (304) 587-2464
- NPI assigned
- Jun 5, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 34
Hospital & facility affiliations 15
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- West Virginia University School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- MSRC LLC
Community Care of West Virginia, Inc.
THS Physician Partners Inc
Practice addresses (Care Compare)
102 Patrick St PLZ
Charleston, WV 25387-2444
Phone (304) 233-3200
235 Skidmore LN
Sutton, WV 26601-9272
Phone (304) 765-4400
266 Skidmore LN
Sutton, WV 26601-9271
Phone (304) 765-0351
4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800
Hospital & facility affiliations
- Centerwell Home Health
- Adoration Home Health
- Thomas Memorial Hospital
- Charleston Area Medical Center
- Boone Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090805000480 | WV | Practitioner - Nurse Practitioner | 5799838959 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52119 | WV | MD | Family Nurse Practitioner |
Practice roles
Locations
L3539
Columbus, OH 43260
Phone (304) 414-4800
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
4 Northridge Dr
Ste 118
Buckhannon, WV 26201
Phone (304) 473-1440
16 College Ave
Buckhannon, WV 26201
Phone (304) 472-3310
102 Patrick Street Plz
Charleston, WV 25387
Phone (304) 223-3200
3701 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 720-2345
271 Warrior Way
Dunmore, WV 24934
Phone (304) 799-0515
4498 Potomac Highlands Trl
Green Bank, WV 24944
Phone (304) 456-5115
797 Clinic Dr
Ivydale, WV 25113
Phone (304) 286-4200
821 3rd Ave
Marlinton, WV 24954
Phone (304) 799-4404
926 5th Ave
Ste A
Marlinton, WV 24954
Phone (304) 799-4916
78 Queens Alley Rd
Rock Cave, WV 26234
4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800
235 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-4400
100 Carter Braxton Dr
Sutton, WV 26601
Phone (304) 765-2644
266 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-0351
149 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022
Interoperability endpoints
- tracie.boner.1@4803.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 52119 | WV | Yes |
Addresses
Primary practice location
122 Center St
Clay, WV 25043-7046
Mailing address
122 Center St
Clay, WV 25043-7046
Phone (304) 587-7301
Other practice location 1
3701 MacCorkle Ave SE
Charleston, WV 25304-1525
Phone (304) 720-2345
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679709554 | Medicaid | WV | |
| 52119 | Other | WV | STATE NP LICENSE |
Other names
- Tracie F Boner
Other providers in Clay, WV
- Anita Sue Blankenship
- Mavis Jean Bleigh
- Michelle Lea Bodkins
- Abigail Rene Boggs
- Daisy Marie Bollinger
- Bowen & Bowen, PLLC
- Gary M Bowen II
- Stacy L Bowen
- Jennifer Bragg
- Patricia L Bragg
All providers in Clay, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.