NPI 1386270908 · live from the CMS NPI Registry
Bonnie Lynn Blackburn, PA
Physician Assistant, Medical in Buckhannon, WV. National Provider Identifier 1386270908, active.
NPI record
| NPI | 1386270908 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 10 Amalia Dr Ste C5, Buckhannon, WV 26201 |
| Practice phone | 304-460-7948 |
| Mailing address | 1 Amalia Dr, Buckhannon, WV 26201 |
| Enumerated | March 15, 2020 |
| Last updated | September 15, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical primary | 363AM0700X | 2411 (WV) |
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.