Healthcare Provider Details

I. General information

NPI: 1861845299
Provider Name (Legal Business Name): MICHAEL BRYAN BOLING APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST N217
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST N217
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax:
Mailing address:
  • Phone: 859-323-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number3010492
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3010492
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: