Provider Demographics
NPI:1588841035
Name:BOLT, KATHRYN DORWEILER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:DORWEILER
Last Name:BOLT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1601 E 19TH AVE STE 6250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1291
Mailing Address - Country:US
Mailing Address - Phone:303-563-2755
Mailing Address - Fax:303-861-6219
Practice Address - Street 1:1601 E 19TH AVE STE 6250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1291
Practice Address - Country:US
Practice Address - Phone:303-563-2755
Practice Address - Fax:303-861-6219
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2729363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68603533Medicaid
CO2729OtherCOLORADO PA BOARD
COP01638571Medicare PIN
CO480705ZLF7Medicare PIN