Provider Demographics
NPI:1396731287
Name:BOLING, VICKI L (APRN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:BOLING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-0219
Mailing Address - Country:US
Mailing Address - Phone:406-252-5658
Mailing Address - Fax:406-238-3617
Practice Address - Street 1:1245 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0122
Practice Address - Country:US
Practice Address - Phone:406-252-5658
Practice Address - Fax:406-238-3617
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN12342363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT373530OtherBLUE CROSS BLUE SHIELD
P00086831OtherRAILROAD MEDICARE
P00086831OtherRAILROAD MEDICARE
MT373530OtherBLUE CROSS BLUE SHIELD