Healthcare Provider Details

I. General information

NPI: 1629497748
Provider Name (Legal Business Name): BARBARA EMILY BOLEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SAN ANTONIO ST
LOCKHART TX
78644-2421
US

IV. Provider business mailing address

4303 VICTORY DR STE 100
AUSTIN TX
78704-7507
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-5247
  • Fax:
Mailing address:
  • Phone: 512-462-3627
  • Fax: 512-462-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: