Bonita Marie Kelm

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

271296 Issued in TN

Practice address

170 Kasen LN
Ethridge, TN 38456-3001

Phone

(731) 458-7046

Fax

(731) 458-7046

NPI assigned

Oct 7, 2026

Last updated

Oct 7, 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

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1791331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1760386197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 KASEN LN",
            "city": "ETHRIDGE",
            "state": "TN",
            "postal_code": "384563001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 KASEN LN",
            "city": "ETHRIDGE",
            "state": "TN",
            "postal_code": "384563001",
            "telephone_number": "731-458-7046",
            "fax_number": "731-458-7046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELM",
        "first_name": "BONITA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-07",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TN",
            "license": "271296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Ethridge, TN
• Providers in Ethridge, TN by specialty
• Student in an Organized Health Care Education/Training Program in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.