Sally Diane Bonham, BSN, MSN, FNP, IBCLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1182184 Issued in TX

Practice address

3500 Hillcrest Dr Ste 1
Waco, TX 76708-3144

Phone

(254) 741-6641

Fax

(257) 453-7469

NPI assigned

Jan 31, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sally Diane Taylor Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mark Malone MD PAGroup PAC ID 2567369424, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sally.diane.bonham.1@24201.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark Malone MD PA

  • Pain Medicine (Anesthesiology) Physician
  • Round Rock, TX
  • NPI 1407057250
  Medicare reassignment Care Compare group NPD
• Mark Malone, MD PA

  • Pain Medicine (Anesthesiology) Physician
  • Killeen, TX
  • NPI 1982581427
  NPD
• The Breastfeeding Success Company, LLC

  • Pediatrics Physician
  • Austin, TX
  • NPI 1609275858

  Lactation Consultant

  NPD (past)

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1811750078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W LOUIS HENNA BLVD STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787281203",
            "telephone_number": "512-244-4272",
            "fax_number": "512-244-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 HILLCREST DR STE 1",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083144",
            "telephone_number": "254-741-6641",
            "fax_number": "257-453-7469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 S Mays St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Round Rock",
            "state": "TX",
            "postal_code": "786647580",
            "country_code": "US",
            "telephone_number": "512-244-4272",
            "fax_number": "512-244-2895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONHAM",
        "first_name": "SALLY",
        "middle_name": "DIANE",
        "credential": "BSN, MSN, FNP, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-31",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "TX",
            "license": "638280",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1182184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "TAYLOR",
            "middle_name": "DIANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Debra Sue Bolt, MSW
• Brett J Bolte, MD
• Jessica Boltinghouse, PSY. D.
• David Boman, DC, CFMP, OT/L, MBA
• Katelyn Bone, APRN FNP
• Anna Christine Bonner
• Corbett Howard Boone, M.D.
• Nata Marie Boone, LPC
• Kathileen Riley Boozer, CFNP
• Bop Dental Specialists

• Family Nurse Practitioner in Waco, TX
• Providers in Waco, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.