Individual
BONITA C AYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 DODD ST, SPRING HOPE, NC 27882-9348
(252) 478-5412
(252) 937-3100
Mailing address
PO BOX 7200, ROCKY MOUNT, NC 27804-0200
(252) 937-0200
(252) 451-0056
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200892
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619961620
NPI
NC
01
—
363L00000X
TAXONOMY
NC
01
—
500005810
RAILROAD MEDICARE
NC
01
—
58594
MEDICAL LICENSE
NC
05
—
7000422
—
NC
Enumeration date
09/06/2005
Last updated
03/07/2023
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