Basic Information
| Provider Information | |||||||||
| NPI: | 1659362861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | CNM, WHCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21542 E 826 RD | ||||||||
| Address2: | |||||||||
| City: | PARK HILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744514140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184583344 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 S BLISS AVE | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744642512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184583344 | ||||||||
| FaxNumber: | 9184583315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 04/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R0031750 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | R0031750 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.