Kimberly Ellen Boldon, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

6303 Issued in CT

Practice address

11 S Main St
Middletown, CT 06457-3656

Phone

(860) 347-4555

NPI assigned

Sep 24, 2015

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

The Dermatology Center of Connecticut LLCGroup PAC ID 7618308214, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Dermatology Center of Connecticut, LLC

  • Dermatology Physician
  • Wallingford, CT
  • NPI 1922633213
  Medicare reassignment Care Compare group NPD Authorized official
• Middlesex Dermatology, LLC

  • Dermatology Physician
  • Middletown, CT
  • NPI 1376089003
  Medicare reassignment
• TDG Connecticut PLLC

  • Dermatology Physician
  • New Haven, CT
  • NPI 1245744846
  NPD

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083083638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573656",
            "telephone_number": "860-347-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573656",
            "telephone_number": "860-347-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDON",
        "first_name": "KIMBERLY",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "6303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Hills Behavioral Health
• Ginger Elaine Blume, PH D
• Michele Salonia Boccalatte, D.M.D
• Brian Boehme
• Makayla Boisvert
• Dina R Bolella
• Rachel Miriam Bonaparte, LCSW
• Laura Bony, M.D.
• Edward Robert Boothroyd, D.M.D.
• Caitlin Boots

• Nurse Practitioner in Middletown, CT
• Providers in Middletown, CT by specialty
• Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.