Mary L Bouldin, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01040813A Issued in IN

Practice address

460 Spring St
Jeffersonville, IN 47130-3452

Phone

(812) 280-2080

NPI assigned

Dec 11, 2006

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• State of Indiana, Auditor of State

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1700876224
  NPD

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467512566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 DILLON DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052803",
            "telephone_number": "812-280-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 SPRING ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303452",
            "telephone_number": "812-280-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01040813A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elbert Boquiren, ELBERT BOQUIREN
• Jerry Wayne Boston, L.C.S.W.
• Morgan Boston
• Tania Boswell
• Dezmon Bott
• Danielle M Bowen
• Gracey L. Bowen, MSSW
• Leigha Bowyer Jones, APN
• Saydie Bowyer
• Tina Naylor Bradley, MD

• Psychiatry Physician in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.