Provider Demographics
NPI:1851176887
Name:YOUR CARE DOWN THERE: AN ONLINE STD CLINIC
Entity Type:Organization
Organization Name:YOUR CARE DOWN THERE: AN ONLINE STD CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:346-491-6839
Mailing Address - Street 1:9115 FM 723 RD STE 550
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-9238
Mailing Address - Country:US
Mailing Address - Phone:346-491-6839
Mailing Address - Fax:
Practice Address - Street 1:9115 FM 723 RD STE 550
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-9238
Practice Address - Country:US
Practice Address - Phone:346-491-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty