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General NPI Number Information
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NPI Number | 1144815960
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Entity Type | Individual
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Provider Name | LATOIA T BOLTON DNP APRN NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 7 LAKELAND CIR STE 500
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City | JACKSON
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State | MS
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Zip | 39216-5022
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Country | US
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Telephone | 601-300-3935
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Fax | 769-241-0003
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Provider Business Mailing Address
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Address Line | 180 BROOKLYNN ST
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City | BYRAM
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State | MS
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Zip | 39272-4518
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Country | US
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Telephone | 601-940-6505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 904497
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License Number State | MS
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