Provider Demographics
NPI:1235318155
Name:MINTON, BONNIE H (PA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:H
Last Name:MINTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-9400
Mailing Address - Country:US
Mailing Address - Phone:256-276-0501
Mailing Address - Fax:
Practice Address - Street 1:1411 WALKER DRIVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:AL
Practice Address - Zip Code:35905
Practice Address - Country:US
Practice Address - Phone:256-276-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant