Provider Demographics
NPI:1184618670
Name:BOLT, JOY ROTTON (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ROTTON
Last Name:BOLT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:LESLIE
Other - Last Name:ROTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:960 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5735
Mailing Address - Country:US
Mailing Address - Phone:256-891-0403
Mailing Address - Fax:
Practice Address - Street 1:2505 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5908
Practice Address - Country:US
Practice Address - Phone:256-593-8310
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-017806367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered