Healthcare Provider Details

I. General information

NPI: 1902173057
Provider Name (Legal Business Name): KAREN D BOLTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BROADWAY ST.
PEARLAND TX
77581
US

IV. Provider business mailing address

2017 BROADWAY ST.
PEARLAND TX
77581
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-9990
  • Fax: 281-859-9469
Mailing address:
  • Phone: 281-485-9990
  • Fax: 281-859-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number737395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: