Provider Demographics
NPI:1669816492
Name:BOLT, ASHLEE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:BOLT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10620 TREENA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1140
Mailing Address - Country:US
Mailing Address - Phone:858-255-0878
Mailing Address - Fax:567-240-6479
Practice Address - Street 1:10620 TREENA ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1140
Practice Address - Country:US
Practice Address - Phone:858-255-0878
Practice Address - Fax:567-240-6479
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95008669363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health