Provider Demographics
NPI:1043472541
Name:BOONE, NICOLE MICHELLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:BOONE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FIDDLERS RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3484
Mailing Address - Country:US
Mailing Address - Phone:770-716-8781
Mailing Address - Fax:
Practice Address - Street 1:115 FIDDLERS RDG
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3484
Practice Address - Country:US
Practice Address - Phone:770-716-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily