Kelly Bonavena, L.AC, MSOM

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC 00003070 Issued in WA

Practice address

102 N Meridian
Unit 3a
Puyallup, WA 98371-8630

Phone

(253) 970-8256

Fax

(206) 420-7133

NPI assigned

Jul 23, 2008

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217203200000",
    "number": "1841455342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 SHOREWOOD DR SW",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981462411",
            "telephone_number": "203-824-2625",
            "fax_number": "206-420-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N MERIDIAN",
            "address_2": "UNIT 3A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983718630",
            "telephone_number": "253-970-8256",
            "fax_number": "206-420-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVENA",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "L.AC, MSOM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2008-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC 00003070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Boland
• Karen Bolanoz-Lopez
• Dametra Lynthia Bolar
• Marilyn Bollinger
• Bailey N. Boltz, PA-C
• Bonaventure of Puyallup
• Holly Anne Bonnardel, LMFTA
• Nicole Malene Bosch
• Sylvia E Boskovich III
• Jodie Bosma

• Acupuncturist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Acupuncturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.