Provider Demographics
NPI:1790677623
Name:BOURNE, HAYDEE (FNP)
Entity type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 HEART WOOD LOOP RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9419
Mailing Address - Country:US
Mailing Address - Phone:315-286-4118
Mailing Address - Fax:
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 305
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4179
Practice Address - Country:US
Practice Address - Phone:910-641-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily