Mary Darlene Bolton, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R79429 Issued in MS

Practice address

605 Stadium Dr
Hattiesburg, MS 39401-4156

Phone

(601) 450-0310

Fax

(601) 450-0321

NPI assigned

Dec 27, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1346227741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-3700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 STADIUM DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014156",
            "telephone_number": "601-450-0310",
            "fax_number": "601-450-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "MARY",
        "middle_name": "DARLENE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R79429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114669",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3565141",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4593131",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Torkeshia Bolar
• Blake Edwin Boleware
• Empress Bolton
• Kimneesha Bolton
• Lacetria Bolton
• Matthew Dane Bolton, CNP
• Shantele Hinton Bolton, M.D.
• David W Bomboy, MD
• Christopher Lamar Bond, DNP, CRNA
• Garrett Cole Bond, AG-ACNP

• Family Nurse Practitioner in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; 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.