Provider Demographics
NPI:1275811010
Name:BOKLAGE, JAMES LAWRENCE SR (APRN-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:BOKLAGE
Suffix:SR
Gender:M
Credentials:APRN-C
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BOKLAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1113 DEER HVN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-5205
Mailing Address - Country:US
Mailing Address - Phone:502-545-8382
Mailing Address - Fax:
Practice Address - Street 1:1113 DEER HVN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-5205
Practice Address - Country:US
Practice Address - Phone:502-545-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007047261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service