Provider Demographics
NPI:1235644451
Name:BOLDEN, CHRISTA A (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:A
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W SANER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-1430
Mailing Address - Country:US
Mailing Address - Phone:214-331-0567
Mailing Address - Fax:214-337-7779
Practice Address - Street 1:3201 W SANER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-1430
Practice Address - Country:US
Practice Address - Phone:214-331-0567
Practice Address - Fax:214-337-7779
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135795363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner