Provider Demographics
NPI:1912787904
Name:BOLDEN, KAIYA (RN)
Entity Type:Individual
Prefix:
First Name:KAIYA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-7818
Mailing Address - Country:US
Mailing Address - Phone:845-888-2471
Mailing Address - Fax:845-796-5074
Practice Address - Street 1:28 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WURTSBORO
Practice Address - State:NY
Practice Address - Zip Code:12790-7818
Practice Address - Country:US
Practice Address - Phone:845-888-2471
Practice Address - Fax:845-796-5074
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639796163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool