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NPI Code Detail

MEDICARE: KRISTEN MICHELLE BOLD P.A.-C

MEDICARE: KRISTEN MICHELLE BOLD P.A.-C
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
1363AM0700XMedical Physician AssistantTX

General Provider Information

NPI Number : 1851646491
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN MICHELLE BOLD P.A.-C
Provider Business Mailing Address
First Line : 4440 E HIGHWAY 287
Second Line :
City : MIDLOTHIAN
State : TX
Zip : 76065-5576
Country : US
Telephone Number : 972-723-5590
Fax Number : 972-723-5592
Provider Business Practice Location Address
First Line : 4440 E HIGHWAY 287
Second Line :
City : MIDLOTHIAN
State : TX
Zip : 76065-5576
Country : US
Telephone Number : 972-723-5590
Fax Number : 972-723-5592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2012
Last Update Date : 07/19/2012

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Directions to “ KRISTEN MICHELLE BOLD P.A.-C” Practice Location

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