IndividualActive
Bonnie Clark, PA C
NPI 1508899170 · Medical Physician Assistant · Albuquerque, NM
Provider details
- NPI number
- 1508899170
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA C
- Sex
- Female
- Sole proprietor
- No
- License
- 79-PA004 (NM)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
5400 Gibson Blvd Se
Albuquerque, NM 87108-4729
Phone: (505) 262-7026
Fax: (505) 727-9276
Approximate (ZIP-level) locationGet directions
Mailing address
5400 Gibson Blvd Se
Albuquerque, NM 87108-4729
Registry dates
- Enumerated
- 2006-07-08
- Last updated
- 2008-12-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.