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NPI Code Detail

MEDICARE: MRS. CAROL ANN BOLT PA

MEDICARE: MRS. CAROL ANN BOLT PA
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
1363A00000XPhysician AssistantPA0004322CO
2363A00000XPhysician Assistant000102439NC
3363A00000XPhysician Assistant61678220WA

Other Identifiers

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

General Provider Information

NPI Number : 1265468425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL ANN BOLT PA
Provider Business Mailing Address
First Line : 6060 PORTAL WAY
Second Line :
City : FERNDALE
State : WA
Zip : 98248-7833
Country : US
Telephone Number : 360-676-6177
Fax Number : 360-671-3574
Provider Business Practice Location Address
First Line : 6060 PORTAL WAY
Second Line :
City : FERNDALE
State : WA
Zip : 98248-7833
Country : US
Telephone Number : 360-676-6177
Fax Number : 360-671-3574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 05/15/2026

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Directions to “ MRS. CAROL ANN BOLT PA” Practice Location

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