Active NPI
Annette Bolden
- Homemaker
- Shreveport, LA
National Provider Identifier
1710686407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- 30042
- Practice address
- 1545 Line Ave Ste 330a
Shreveport, LA 71101-4600 - Phone
- (318) 409-9636
- NPI assigned
- Mar 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Homemaker | 376J00000X | 30042 | LA | Primary |
Addresses
Primary practice location
1545 Line Ave Ste 330a
Shreveport, LA 71101-4600
Mailing address
1931 Ashton St
Shreveport, LA 71103-2625
Phone (318) 409-9636
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30042 | LA | MD | Homemaker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uniquelytailored Sitter Service | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- In Home Supportive Care Agency
- Shreveport, LA
- NPI 1902506421
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677628800000",
"number": "1710686407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1931 ASHTON ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711032625",
"telephone_number": "318-409-9636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1545 LINE AVE STE 330A",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014600",
"telephone_number": "318-409-9636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDEN",
"first_name": "ANNETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-01",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "LA",
"license": "30042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.