Provider Demographics
NPI:1457759185
Name:BOLDON, DARLENE (CNA)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:BOLDON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12435 DESSAU RD
Mailing Address - Street 2:APT 1121
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-1980
Mailing Address - Country:US
Mailing Address - Phone:512-905-6083
Mailing Address - Fax:
Practice Address - Street 1:12435 DESSAU RD
Practice Address - Street 2:APT 1121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-1980
Practice Address - Country:US
Practice Address - Phone:512-905-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37814172V00000X
TXNA10082522376K00000X
IA355674014376K00000X
TX35453989172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver