MEDICARE: MRS. DAWDA KINSHASA BOLTON N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP117100	TX

General Provider Information

NPI Number	:	1760639926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWDA KINSHASA BOLTON N.P.

Provider Business Mailing Address
First Line	:	8751 COLLIN MCKINNEY PKWY STE 1102
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1872
Country	:	US
Telephone Number	:	972-668-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8751 COLLIN MCKINNEY PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1656
Country	:	US
Telephone Number	:	972-668-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	05/08/2023

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