Provider Demographics
NPI:1962485870
Name:BONE, INA KAY
Entity Type:Individual
Prefix:MRS
First Name:INA
Middle Name:KAY
Last Name:BONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4842
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602
Mailing Address - Country:US
Mailing Address - Phone:423-247-7030
Mailing Address - Fax:423-247-7033
Practice Address - Street 1:2020 BROOKSIDE DR
Practice Address - Street 2:SUITE 20
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4633
Practice Address - Country:US
Practice Address - Phone:423-247-7030
Practice Address - Fax:423-247-7033
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7279363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3342976Medicaid
TN3342976Medicaid
TN3342976Medicare ID - Type Unspecified