Provider Demographics
NPI:1689893810
Name:BOLTON, DEBBIE ANN (APN)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 PROFESSIONAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5138
Mailing Address - Country:US
Mailing Address - Phone:423-820-0432
Mailing Address - Fax:423-525-8795
Practice Address - Street 1:712 PROFESSIONAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5138
Practice Address - Country:US
Practice Address - Phone:423-820-0432
Practice Address - Fax:423-525-8795
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 12678363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I8882Medicare PIN