Bolton, Mary Darlene
Bolton, Mary Darlene is an individual health care provider with primary practice located at 605 Stadium Dr , Hattiesburg MS 39401-4156. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Bolton, Mary Darlene can be contacted via phone (601) 450-0310.Contact Information
Primary practice address
605 Stadium Dr
Hattiesburg MS 39401-4156
Phone: (601) 450-0310
Fax: (601) 450-0321
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | R79429 | Mississippi |
Profile Details
| NPI number | 1346227741 |
|---|---|
| LBN Legal business name | Bolton, Mary Darlene |
| Credentials | FNP-BC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 27th, 2005 |
| Last updated | May 1st, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346227741 | NPPES |
| Mississippi | MEDICAID | 00114669 | |
| Mississippi | Other | 3565141 | |
| Mississippi | Other | 4593131 |
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