1386329373 NPI number — MRS. KNAKISHA SHONDALE BONEY LMT

Table of content: MRS. KNAKISHA SHONDALE BONEY LMT (NPI 1386329373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386329373 NPI number — MRS. KNAKISHA SHONDALE BONEY LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONEY
Provider First Name:
KNAKISHA
Provider Middle Name:
SHONDALE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONEY
Provider Other First Name:
KISHA
Provider Other Middle Name:
SHONDALE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386329373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 HOPE MILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-978-4743
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 HOPE MILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-978-4743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  16406 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com