Provider Demographics
NPI:1497772966
Name:BOLGER, KATHLEEN M (MS APRN BC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:BOLGER
Suffix:
Gender:F
Credentials:MS APRN BC
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 225
Mailing Address - Street 2:C/O HOMEBASE BILLING
Mailing Address - City:WEST ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13861
Mailing Address - Country:US
Mailing Address - Phone:607-263-5987
Mailing Address - Fax:607-263-5987
Practice Address - Street 1:2410 WALLEY ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NY
Practice Address - Zip Code:13775
Practice Address - Country:US
Practice Address - Phone:607-829-3704
Practice Address - Fax:607-829-2117
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRN4923691363LP0808X
NYNPPF4007351363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMB1311288OtherDEA
NYMB1311288OtherDEA