Provider Demographics
NPI:1578675260
Name:HUNEYCUTT, BOUASY L (MD)
Entity Type:Individual
Prefix:DR
First Name:BOUASY
Middle Name:L
Last Name:HUNEYCUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANDERBILT PARK DRIVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3245
Mailing Address - Country:US
Mailing Address - Phone:828-274-9920
Mailing Address - Fax:828-274-9924
Practice Address - Street 1:1 VANDERBILT PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1766
Practice Address - Country:US
Practice Address - Phone:828-274-9920
Practice Address - Fax:828-274-9924
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01666208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2643910-00Medicaid
NC5908306Medicaid
FL2643910-00Medicaid
NC2074757Medicare PIN
NC2074757Medicare PIN