Provider Demographics
NPI:1366109894
Name:BONEY, JENNIFER TILLMAN (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TILLMAN
Last Name:BONEY
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 BEDGOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8515
Mailing Address - Country:US
Mailing Address - Phone:252-265-9200
Mailing Address - Fax:
Practice Address - Street 1:208 MALLOY ST STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4478
Practice Address - Country:US
Practice Address - Phone:984-520-6080
Practice Address - Fax:984-520-6081
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC171855163WP0808X
NC5015694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health