Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

McKenzie Bonifield

Individual provider Family Nurse Practitioner · NPI 1205411204

McKenzie Bonifield is a Nurse Practitioner in Carbondale, Illinois. Qualified in 2020, 6 years ago. Practices with Shawnee Health Service and Development Corp, a 51-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Licensed in
IL
In the registry since
2021
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Practice location Address checks out

400 S Lewis Ln
Carbondale, IL 62901-3547
Phone: (618) 519-9200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209022703 (IL)

Record details

NPI number1205411204
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 11, 2021
Last updated in NPPESMarch 17, 2021
Certification dateMarch 17, 2021
Mailing address109 California St, Po Box 577, Carterville, IL 62918-0577

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Shawnee Health Service And Development Corp — 51 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations9 on file with Medicare

Other providers in Carbondale