Provider Demographics
NPI:1568700029
Name:BOLTON, SHAMEKA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAMEKA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 SUNRISE GLEN LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2745
Mailing Address - Country:US
Mailing Address - Phone:520-965-5784
Mailing Address - Fax:
Practice Address - Street 1:1313 HERMANN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7005
Practice Address - Country:US
Practice Address - Phone:713-527-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126551363LA2100X, 363LP0808X, 363LA2100X
AZAP9676363LP0808X
NV815602363LP0808X
WAAP6104491363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health