MEDICARE: MICHEAL E BOLES PHD APRN BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN6428	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4343158	OTHER	TN	BCTN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033216569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEAL E BOLES PHD APRN BC

Provider Business Mailing Address
First Line	:	PO BOX 427
Second Line	:
City	:	CELINA
State	:	TN
Zip	:	38551-0427
Country	:	US
Telephone Number	:	931-243-3860
Fax Number	:	931-243-4607

Provider Business Practice Location Address
First Line	:	PO BOX 388
Second Line	:
City	:	CELINA
State	:	TN
Zip	:	38551-0388
Country	:	US
Telephone Number	:	931-243-3860
Fax Number	:	931-243-4607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	11/06/2017

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