Basic Information
| Provider Information | |||||||||
| NPI: | 1477559649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLTON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DC, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385011726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317835582 | ||||||||
| FaxNumber: | 9315266760 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 N CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385012421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317835353 | ||||||||
| FaxNumber: | 9317834994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2108 | TN | N | Chiropractic Providers | Chiropractor | 111NR0400X | 2108 | TN | N | Chiropractic Providers | Chiropractor | Rehabilitation | 163W00000X | 208311 | TN | N | Nursing Service Providers | Registered Nurse | 363LP2300X | 24437 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 24437 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 24437 | 01 | TN | ADVANCED PRACTICE REGISTERED NURSE | OTHER |