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NPI Code Detail

MEDICARE: MS. TIRA LYNN BOLDER NP

MEDICARE: MS. TIRA LYNN BOLDER NP
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
1363LA2100XAcute Care Nurse Practitioner53-460003-032KS
2363LA2100XAcute Care Nurse PractitionerAP121853TX

General Provider Information

NPI Number : 1902176605
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIRA LYNN BOLDER NP
Provider Business Mailing Address
First Line : 475 E FM 1382 UNIT 4321
Second Line :
City : CEDAR HILL
State : TX
Zip : 75106-5198
Country : US
Telephone Number : 945-240-1598
Fax Number :
Provider Business Practice Location Address
First Line : 4500 S LANCASTER RD
Second Line :
City : DALLAS
State : TX
Zip : 75216-7167
Country : US
Telephone Number : 214-857-4316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 02/21/2025

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