Provider Demographics
NPI:1073723854
Name:BOLTON, KATHY LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:859-858-9355
Mailing Address - Fax:859-858-0416
Practice Address - Street 1:1250 KEENE RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7600
Practice Address - Country:US
Practice Address - Phone:859-858-9355
Practice Address - Fax:859-858-0416
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100123020Medicaid
KYK134010Medicare PIN