Provider Demographics
NPI:1063625952
Name:KITCHEN, BONNIE LYNN (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYNN
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 HAVANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6558
Mailing Address - Country:US
Mailing Address - Phone:817-849-8448
Mailing Address - Fax:
Practice Address - Street 1:1864 NORWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-268-6200
Practice Address - Fax:817-280-0673
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98002176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife