Provider Demographics
NPI:1750602132
Name:BOLEY, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 PARK AVE
Mailing Address - Street 2:APT. #4
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-4580
Mailing Address - Country:US
Mailing Address - Phone:650-868-1945
Mailing Address - Fax:
Practice Address - Street 1:931 CHATHAM LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2417
Practice Address - Country:US
Practice Address - Phone:614-533-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60258185163WP0000X
WAAP60258141363LA2200X
OHRN.332736-1363LA2200X
OH18988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health