Bonita A Spade, FNP,CDE

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R64665 Issued in SC

Practice address

2845 Tricom St
North Charleston, SC 29406-9172

Phone

(843) 797-1770

Fax

(843) 553-1498

NPI assigned

Nov 29, 2006

Last updated

Jul 9, 2007By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1861569329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-797-1770",
            "fax_number": "843-553-1498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-797-1770",
            "fax_number": "843-553-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPADE",
        "first_name": "BONITA",
        "middle_name": "A",
        "credential": "FNP,CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "R64665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0283",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC STATE ID #",
            "identifier": "R64665",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Carolina CVS Pharmacy, L.L.C. (CVS Pharmacy # 00626)
• South Carolina Dept of Mental Health Accounting Office (Tricounty Crisis Stabilization Center)
• South Carolina Dhec (Diabetes Education Program Trident)
• South Carolina PHS PC
• Terri Southard, MS, LPC
• Jennifer Kirby Spaker, RN
• Frank Carl Sparacino, D.D.S.
• Spark Your Speech LLC
• Bruce Grove Sparks, PHARMACIST
• Emilee Sparks

• Adult Health Nurse Practitioner in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Adult Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.