MEDICARE: KATHY LYNN BOLTON ARNP

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	363L00000X	Nurse Practitioner	3004184	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073723854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LYNN BOLTON ARNP

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST
Second Line	:	SUITE 800
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1434
Country	:	US
Telephone Number	:	859-858-9355
Fax Number	:	859-858-0416

Provider Business Practice Location Address
First Line	:	1250 KEENE RD
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-7600
Country	:	US
Telephone Number	:	859-858-9355
Fax Number	:	859-858-0416

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/16/2016

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