Bouldin, Douglas Allen

Bouldin, Douglas Allen is an individual health care provider with primary practice located at 13353 Olive Blvd , Chesterfield MO 63017-3108. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Bouldin, Douglas Allen can be contacted via phone (636) 473-8873.

Contact Information

Primary practice address
13353 Olive Blvd Chesterfield MO 63017-3108
Phone: (636) 473-8873
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 113431 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 3009332 Kentucky

Profile Details

NPI number 1770568727
LBN Legal business name Bouldin, Douglas Allen
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Mar 16th, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770568727 NPPES
Missouri MEDICAID 425690617

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