Individual ProviderBonnie Jeanne KellySocial WorkerBehavioral Health & Social Service ProvidersPractice Address708 Mobjack Pl, Newport News, VA 23606-1957(757) 873-1958PECOS EnrollmentThis provider is enrolled in PECOS as BONNIE KELLY.Based on the most recent information from CMS, provider Bonnie Jeanne Kelly is legally eligible to order and refer claims for DME services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861420366Provider TypeIndividualFull NameKelly, Bonnie JeanneCredentialL.C.S.W.GenderFemaleSole ProprietorYesEnumeration Date6/30/2006Last Updated2/7/2019Contact InformationPractice LocationPractice Address708 Mobjack Pl, Newport News, VA 23606-1957Phone(757) 873-1958Fax(757) 873-2143Mailing LocationMailing Address708 Mobjack Pl, Newport News, VA 23606-1957Phone(757) 873-1958Fax(757) 873-2143Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense0904000483VirginiaProvider IdentifiersIDDescriptionIssuerID2109871DescriptionOtherIssuerMAMSIVirginiaID86862DescriptionOtherIssuerSENTARAVirginiaID5359671DescriptionOtherIssuerAETNAVirginiaID331939DescriptionOtherIssuerANTHEM BC/BSVermontID008952914DescriptionMedicaidIssuerUnlistedVirginiaID043493DescriptionOtherIssuerVALUE OPTIONSVirginia