Provider Demographics
NPI:1376153544
Name:BOLEN, MELANIE SHEVONNE (DNP, APRN-CNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SHEVONNE
Last Name:BOLEN
Suffix:
Gender:F
Credentials:DNP, APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-1235
Practice Address - Street 1:7300 DOLLARWAY RD STE 116
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3023
Practice Address - Country:US
Practice Address - Phone:702-477-0888
Practice Address - Fax:870-247-7089
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily