Basic Information
| Provider Information | |||||||||
| NPI: | 1376153544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLEN | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | SHEVONNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN-CNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720060497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8703471235 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 DOLLARWAY RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | WHITE HALL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716023023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024770888 | ||||||||
| FaxNumber: | 8702477089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 125425 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.