Active NPI
Brenda S. Boling
- Nurse Practitioner
- Louisville, KY
National Provider Identifier
1306898606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4079P
- Practice address
- 315 E Broadway
Louisville, KY 40202-1703 - Phone
- (502) 629-2500
- Fax
- (502) 629-3166
- NPI assigned
- May 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4079P | KY | Primary |
Addresses
Primary practice location
315 E Broadway
Louisville, KY 40202-1703
Mailing address
PO Box 776347
Chicago, IL 60677-6347
Phone (502) 629-2500
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000310996 | Other | KY | ANTHEM PROVIDER NO. |
| 50006768 | Other | KY | PASSPORT PROVIDER NO |
| 78013604 | Medicaid | KY | |
| P00110157 | Other | KY | RAILROAD MEDICARE |
| 200455700 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4079P | KY | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467849600000",
"number": "1306898606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776347",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606776347",
"telephone_number": "502-629-2500",
"fax_number": "502-629-3166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 E BROADWAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021703",
"telephone_number": "502-629-2500",
"fax_number": "502-629-3166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLING",
"first_name": "BRENDA",
"middle_name": "S.",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-16",
"last_updated": "2016-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "KY",
"license": "4079P",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NO.",
"identifier": "000000310996",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT PROVIDER NO",
"identifier": "50006768",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "78013604",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00110157",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200455700",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.