Nicole Ashley Bores

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704288193 Issued in MI

Practice address

1900 Columbus Ave
Bay City, MI 48708-6831

Phone

(248) 697-7268

NPI assigned

Dec 14, 2021

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 MI

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

State licenses

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 and National Provider Directory roles.

• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933
  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Nurse Practitioner

  Medicare reassignment NPD

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1306505615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7204 E GRAND RIVER AVE LOT 307",
            "city": "PORTLAND",
            "state": "MI",
            "postal_code": "488758824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 COLUMBUS AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487086831",
            "telephone_number": "248-697-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORES",
        "first_name": "NICOLE",
        "middle_name": "ASHLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704288193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexes Louise Booth, LLBSW
• Danielle Booth, LLBSW
• Teri Booth, LLPC
• Christine Borchert
• Cynthia Marie Bordeau, LBSW
• Joshua Bornemann
• Lynnen Bostic
• Terri Botello
• Julie Kathryn Botimer, LAC, DIPL. O.M.
• Lori Lynn Boucard, RN

• Nurse Practitioner in Bay City, MI
• Providers in Bay City, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.