Provider Demographics
NPI:1659655629
Name:BOLDEN, HEATHER NICOLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:NP-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 VAN AALST BLVD
Mailing Address - Street 2:FAMILY MEDICAL HOME MARTIN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:762-408-2705
Mailing Address - Fax:762-408-8105
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:FAMILY MEDICAL HOME MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:762-408-2705
Practice Address - Fax:762-408-8105
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN175548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF0911414OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM
GAF0911414OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM