Healthcare Provider Details

I. General information

NPI: 1730374547
Provider Name (Legal Business Name): MELISSA JOY BOLT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA JOY BOLT CNP

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8226 MENAUL BLVD NE # 610
ALBUQUERQUE NM
87110-4614
US

IV. Provider business mailing address

7683 SE 27TH ST # 351
MERCER ISLAND WA
98040-2804
US

V. Phone/Fax

Practice location:
  • Phone: 505-413-3719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number82653
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: