Provider Demographics
NPI:1578915468
Name:BOLTON, ALISHA (FNP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:FNP
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 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-528-9903
Mailing Address - Fax:704-528-4192
Practice Address - Street 1:138 SHERLOCK DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1916
Practice Address - Country:US
Practice Address - Phone:704-873-1021
Practice Address - Fax:704-838-0706
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily