Bonita T Roby, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

P329470 Issued in MS

Practice address

1762 Eddisville Rd
Durant, MS 39063-2910

Phone

(601) 955-8188

NPI assigned

Jun 5, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591401600000",
    "number": "1033733951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1762 EDDISVILLE RD",
            "city": "DURANT",
            "state": "MS",
            "postal_code": "390632910",
            "telephone_number": "601-955-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1762 EDDISVILLE RD",
            "city": "DURANT",
            "state": "MS",
            "postal_code": "390632910",
            "telephone_number": "601-955-8188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBY",
        "first_name": "BONITA",
        "middle_name": "T",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-06-06",
        "certification_date": "2020-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "P329470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Durant",
            "affiliation": "N",
            "address_1": "1762 Eddisville Rd",
            "city": "Durant",
            "state": "MS",
            "country_code": "US",
            "postal_code": "390632910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mallory Community Health
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• Peace Wellness Mobile Unit
• Tiffany Denice Redd
• Daryl Roby, DMD
• Rodgers Medical Clinic
• Phillip Eric Rodgers, FNP-C
• S&M Medical Clinic
• Shannon Pritchard

• All providers in Durant, MS
• Licensed Practical Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2020; 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.