Provider Demographics
NPI:1255783346
Name:KILLIAN-COBB, BONI LEE (FNP)
Entity type:Individual
Prefix:
First Name:BONI
Middle Name:LEE
Last Name:KILLIAN-COBB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 29TH AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1084
Mailing Address - Country:US
Mailing Address - Phone:828-732-5350
Mailing Address - Fax:828-732-5351
Practice Address - Street 1:212 29TH AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1084
Practice Address - Country:US
Practice Address - Phone:828-326-0658
Practice Address - Fax:828-326-7105
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC237415363L00000X
NC5008706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner