Provider Demographics
NPI:1497224398
Name:BOLDEN, KIMBERLY WAYNE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WAYNE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 EDGER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7293
Mailing Address - Country:US
Mailing Address - Phone:513-291-9353
Mailing Address - Fax:
Practice Address - Street 1:5560 EDGER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7293
Practice Address - Country:US
Practice Address - Phone:513-291-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist