Provider Demographics
NPI:1265468425
Name:BOLT, CAROL ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:BOLT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HOSPITAL LOOP
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-8750
Mailing Address - Country:US
Mailing Address - Phone:970-824-9411
Mailing Address - Fax:
Practice Address - Street 1:750 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-8750
Practice Address - Country:US
Practice Address - Phone:970-824-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000102439363A00000X
COPA0004322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98700057Medicaid
NC2753355RMedicare PIN
NC2753355EMedicare PIN
NC2753355BMedicare PIN
NCP45453Medicare UPIN
NC2753355MMedicare PIN
NC2753355CMedicare PIN
NC2753355JMedicare PIN
NC2753355KMedicare PIN
NC2753355FMedicare PIN
NC2753355GMedicare PIN
NC2753355PMedicare PIN
NCN/AMedicaid
NC2753355HMedicare PIN
NC2753355QMedicare PIN
NC2753355LMedicare PIN
NC2753355GMedicare PIN