Provider Demographics
NPI:1962523126
Name:BONNEL-PHILLIPS, KRISTI L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:BONNEL-PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:156 NORTH 6TH STREET
Mailing Address - Street 2:P.O. BOX 388
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410
Mailing Address - Country:US
Mailing Address - Phone:307-568-2499
Mailing Address - Fax:307-568-2699
Practice Address - Street 1:156 NORTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410
Practice Address - Country:US
Practice Address - Phone:307-568-2499
Practice Address - Fax:307-568-2699
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine