Provider Demographics
NPI:1871081570
Name:BOURNE, AUDRIONNA JANAY
Entity type:Individual
Prefix:MS
First Name:AUDRIONNA
Middle Name:JANAY
Last Name:BOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 EXPOSE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-7920
Mailing Address - Country:US
Mailing Address - Phone:601-740-0713
Mailing Address - Fax:844-788-9104
Practice Address - Street 1:524 EXPOSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-7920
Practice Address - Country:US
Practice Address - Phone:601-740-0713
Practice Address - Fax:844-788-9104
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty