Healthcare Provider Details

I. General information

NPI: 1902176605
Provider Name (Legal Business Name): TIRA LYNN BOLDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 UPTOWN BLVD STE 2000
CEDAR HILL TX
75104-3528
US

IV. Provider business mailing address

475 E FM 1382 UNIT 4321
CEDAR HILL TX
75106-5198
US

V. Phone/Fax

Practice location:
  • Phone: 945-240-1598
  • Fax:
Mailing address:
  • Phone: 945-240-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP121853
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53-460003-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: