Russell L Bolyard, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P00907 Issued in TN

Practice address

1282 Union Ave
Health South Rehabilitation Hospital
Memphis, TN 38104-3414

Phone

(901) 729-5159

NPI assigned

May 8, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1073562997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9477 CEDAR GLEN CV",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380164700",
            "telephone_number": "901-729-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1282 UNION AVE",
            "address_2": "HEALTH SOUTH REHABILITATION HOSPITAL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043414",
            "telephone_number": "901-729-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLYARD",
        "first_name": "RUSSELL",
        "middle_name": "L",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P00907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00951505",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "3100399",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3689428",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josephine Britt Bolin, DO
• Christopher Dion Bolton, COTA
• Corhonda Bolton, OTR
• Rachel Bolton
• William Matthew Bolton, MD
• Allison L Bomar-Hyong, DC
• Susan A Bomar, MA
• Kavita Bomb, MD
• Ritin Bomb, MD
• Colleen Myers Bonadio, LPC

• Psychologist in Memphis, TN
• Providers in Memphis, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.