MRS. TEMICA BOHANNON NIBLACK (NPI# 1598126179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598126179 |
| Entity Type | Individual |
| Full Name | MRS. TEMICA BOHANNON NIBLACK |
| Other Name | TEMICA TERESE BOHANNON |
| Practice Address |
100 Halcyon Ct Fayetteville GA 30214-5375 |
| Practice Telephone | 7702416044 |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN157878 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
RN157878 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
100 HALCYON CT |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-5375 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902456593 | Ana Roselia Santos Burks | Nurse Practitioner | 2041 Valleygate Dr Ste 101, Fayetteville, NC 28304-3746 | 2019-09-16 |
| 1801364377 | Ann Marie Alicia Burke | Nurse Practitioner | 2717 Preston Woods Ln Apt 2, Fayetteville, NC 28304-3627 | 2018-11-02 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1295185213 | Nyaradzo Ogunwo | Nurse Practitioner | 1315 Aztek Pl, Fayetteville, NC 28314-6112 | 2016-06-21 |
| 1043656093 | Sharon Foster-geeter | Nurse Practitioner | 3613 Cape Center Dr, Fayetteville, NC 28304-4457 | 2013-05-17 |
| 1013225697 | Adrian Nicole Lennon | Nurse Practitioner | 2018 Fort Bragg Rd Ste 110a, Fayetteville, NC 28303-7038 | 2010-09-17 |
| 1457361529 | St. Joseph's Imaging | Nurse Practitioner | 4109 Medical Center Dr, Fayetteville, NY 13066-6600 | 2006-08-09 |
| 1821008194 | Toni R. Guzi | Nurse Practitioner | 1260 Highway 54 West, Suite 101, Fayette Care Clinic, Fayetteville, GA 30214 | 2006-08-09 |
| 1588630883 | Nancy Zlomek | Nurse Practitioner | 4212 Medical Center Dr, Eastside Internal Medicine, Fayetteville, NY 13066-6642 | 2006-02-27 |
| 1477197812 | Kimberly G Luckman | Nurse Practitioner | 115 Sumner Rd, Fayetteville, GA 30214-4758 | 2019-10-29 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on MRS. TEMICA BOHANNON NIBLACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.