Healthcare Provider Details

I. General information

NPI: 1992500797
Provider Name (Legal Business Name): KATHERINE PAIGE BOLTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

795 WOODRUFF PLACE MIDDLE DR
INDIANAPOLIS IN
46201-1972
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-5252
  • Fax:
Mailing address:
  • Phone: 317-437-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28251397A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000510A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: