=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578463311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZENIQUE BOLDS PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9049 SPRINGBORO PIKE
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-759-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3950 BEECHWOOD DR
-----------------------------------------------------
City | BELLBROOK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45305-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0043593
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------