Provider Demographics
NPI:1578675260
Name:HUNEYCUTT, BOUASY L (MD)
Entity type:Individual
Prefix:DR
First Name:BOUASY
Middle Name:L
Last Name:HUNEYCUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 KEISLER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7097
Mailing Address - Country:US
Mailing Address - Phone:984-200-9001
Mailing Address - Fax:984-200-5352
Practice Address - Street 1:515 KEISLER DR STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7097
Practice Address - Country:US
Practice Address - Phone:984-200-9001
Practice Address - Fax:984-200-5352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01666207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908306Medicaid
FL2643910-00Medicaid
FL2643910-00Medicaid
NC2074757Medicare PIN
NC2074757Medicare PIN