Basic Information
| Provider Information | |||||||||
| NPI: | 1750602132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MS, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 PARK AVE | ||||||||
| Address2: | APT. #4 | ||||||||
| City: | NEWPORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410714580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508681945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 931 CHATHAM LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145335500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2010 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP60258141 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163WP0000X | RN60258185 | WA | N | Nursing Service Providers | Registered Nurse | Pain Management | 363LA2200X | RN.332736-1 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.