Provider Demographics
NPI:1720267925
Name:WHEELDEN, BONNEY LEE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:BONNEY
Middle Name:LEE
Last Name:WHEELDEN
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1055
Mailing Address - Country:US
Mailing Address - Phone:850-758-0111
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN REGIONAL AREA HEALTH EDUCATION CENTER
Practice Address - Street 2:1601 OWEN DRIVE
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-678-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281059363LF0000X
NC5013199363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3120309 00Medicaid