Provider Demographics
NPI:1104155530
Name:BOONE, ANNA W (ANP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:W
Last Name:BOONE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:233 GILMER STREET
Mailing Address - Street 2:PO BOX 2899
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-1069
Mailing Address - Country:US
Mailing Address - Phone:336-342-6196
Mailing Address - Fax:336-349-7638
Practice Address - Street 1:233 GILMER ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3809
Practice Address - Country:US
Practice Address - Phone:336-342-6196
Practice Address - Fax:336-349-7638
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004530Medicaid
NC7004530Medicaid