Healthcare Provider Details

I. General information

NPI: 1306768726
Provider Name (Legal Business Name): KAREN BOLT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5097 HIGHWAY 135 N
PARAGOULD AR
72450-8776
US

IV. Provider business mailing address

302 LACY ST
LEACHVILLE AR
72438-9739
US

V. Phone/Fax

Practice location:
  • Phone: 870-240-2241
  • Fax:
Mailing address:
  • Phone: 870-240-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR045120
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: