Provider Demographics
NPI:1316214414
Name:BOLDEN, DESTINY (ND, RN)
Entity Type:Individual
Prefix:DR
First Name:DESTINY
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:ND, RN
Other - Prefix:
Other - First Name:BEYOND BOLD
Other - Middle Name:
Other - Last Name:HEALTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:964 HIGH HOUSE RD # 2017
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:964 HIGH HOUSE RD # 2017
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3574
Practice Address - Country:US
Practice Address - Phone:504-345-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 103T00000X, 133V00000X, 171400000X, 171M00000X, 251B00000X, 251S00000X
NE73285163W00000X
NC263319163WA2000X, 163WC0400X, 163WC1500X, 163WN1003X, 207Q00000X, 207R00000X
DCNAT1000727175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health