Haley Bolen, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-145272 Issued in AL

Practice address

1116 Mitt Lary Rd
Northport, AL 35475-4978

Phone

(205) 556-5634

NPI assigned

Jan 21, 2021

Last updated

Jan 21, 2021By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

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

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.

• Relias Emergency Medicine Specialists of Northport, LLC

  • Emergency Medicine Physician
  • Northport, AL
  • NPI 1699261149
  Medicare reassignment NPD
• Relias Emergency Medicine Specialists of Regional, LLC

  • Emergency Medicine Physician
  • Tuscaloosa, AL
  • NPI 1619463163
  Medicare reassignment NPD

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1104416486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 MITT LARY RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354754978",
            "telephone_number": "205-556-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 MITT LARY RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354754978",
            "telephone_number": "205-556-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLEN",
        "first_name": "HALEY",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-145272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Northport",
            "affiliation": "N",
            "address_1": "1116 Mitt Lary Rd",
            "city": "Northport",
            "state": "AL",
            "country_code": "US",
            "postal_code": "354754978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Justin Ray Bevel, MD
• Raven Billups, CRNP
• Black Warrior Behavioral Health LLC
• Rain Henry Blankenship, DMD
• Jessica Lynn Bogucki
• Kelly M Bonnett, CRNP
• Bony F Barrineau MD PC
• Andrew Cody Bounds, FNP-C
• Andrea G Bowden-Evans, CRNP
• Jeni Bowen, LPC

• Family Nurse Practitioner in Northport, AL
• Providers in Northport, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.