Healthcare Provider Details

I. General information

NPI: 1366179095
Provider Name (Legal Business Name): KAREEM BOLES PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MARCO DR STE 200
APEX NC
27502-2540
US

IV. Provider business mailing address

1947 FAHEY DR
APEX NC
27502-7093
US

V. Phone/Fax

Practice location:
  • Phone: 919-636-5240
  • Fax:
Mailing address:
  • Phone: 919-999-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5016737
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: