Provider Demographics
NPI:1487166906
Name:BONOT, KENDALL FELIPE (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:FELIPE
Last Name:BONOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 JOHN HUMPHRIES WYND
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5302
Mailing Address - Country:US
Mailing Address - Phone:919-881-8272
Mailing Address - Fax:
Practice Address - Street 1:3101 JOHN HUMPHRIES WYND
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5302
Practice Address - Country:US
Practice Address - Phone:919-881-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008408363A00000X
NC0010-08760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant