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General NPI Number Information
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NPI Number | 1902465040
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Entity Type | Individual
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Provider Name | KAREN BOLDEN FNP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 6391 HWY 72
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City | BYHALIA
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State | MS
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Zip | 38611
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Country | US
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Telephone | 901-827-1853
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Fax |
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Provider Business Mailing Address
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Address Line | 6391 HIGHWAY 72
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City | BYHALIA
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State | MS
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Zip | 38611-9344
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Country | US
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Telephone | 901-827-1853
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 25457
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903214
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License Number State | MS
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