Bonnie Susanne Brown – Family Medicine Physician

Key facts

NPI: 1699725044
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 33782 (KY)
Practice address: 11969 S Dixie Hwy
Sonora, KY 42776-9739
Phone: (270) 369-9706
Fax: (270) 369-9263
NPI assigned: May 10, 2006
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Mitchell Wicker Jr MD PSC Internal Medicine Physician · Hazard, KY · NPI 1093718116

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Mitchell Wicker Jr MD PSC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	33782	KY	Yes

Addresses

Primary practice location

11969 S Dixie Hwy
Sonora, KY 42776-9739

Mailing address

PO Box 2309
Elizabethtown, KY 42702-2309
Phone (270) 706-1023

Other identifiers

Identifier	Type	State	Issuer
080172384	Other	KY	MCR RAILROAD
2437780000	Other	KY	PASSPORT ADVANTAGE MCR
1133127	Other	KY	PSPT
000000202961	Other	KY	BC/BS PIN
64337827	Medicaid	KY

Other providers in Sonora, KY

All providers in Sonora, KY · Family Medicine Physician in Kentucky

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.