Earlene Bohannon, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

122684 Issued in NC

Practice address

725 Highland Ave
Winston Salem, NC 27101-4206

Phone

(336) 768-7200

Fax

(336) 768-7200

NPI assigned

Dec 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275523200000",
    "number": "1003971821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S STRATFORD RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HIGHLAND AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014206",
            "telephone_number": "336-768-7200",
            "fax_number": "336-768-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHANNON",
        "first_name": "EARLENE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2010-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "122684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "122684",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Lyn Bofenkamp, AMY
• Terrence Dale Bogard, MD
• Jane G. Boggs, MD
• Sylvia Bognar, LAC
• Megan Lauren Bohan
• Richard Boiter, D.O.
• Abinet Boku, M.D
• Ashley Hardy Boles, FNP-C
• Carol Ann Boles, MD
• Bruce Richard Bolling, MD

• Registered Nurse in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Registered Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.