Bold Ark LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BOLD ARK LLC

Practice address

3905 Harrison Rd Ste 500
Loganville, GA 30052-5895

Phone

(678) 898-1927

Fax

(678) 798-8880

NPI assigned

May 6, 2025

Last updated

Mar 27, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olufunke Mukomi Adewunmi, DNP, PMHNP-BCNPI 1942793773

Title

Ceo

Phone

(678) 898-1927

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Olufunke Adewunmi, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Smyrna, GA
  • NPI 1942793773
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774569600000",
    "number": "1740079623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 HARRISON RD STE 500",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525895",
            "telephone_number": "678-898-1927",
            "fax_number": "678-798-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 HARRISON RD STE 500",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525895",
            "telephone_number": "678-898-1927",
            "fax_number": "678-798-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLD ARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-06",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A",
        "authorized_official_last_name": "ADEWUNMI",
        "authorized_official_first_name": "OLUFUNKE",
        "authorized_official_middle_name": "MUKOMI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-898-1927",
        "authorized_official_credential": "DNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Boadu, NP
• Board of Health Walton County (Walton County Health Department Loganville)
• Board of Health Walton County
• Donya Boatwright-Johnson
• Jesty Boby, FNP-C
• Miranda Bollinger
• Jennifer K Bolton, DC
• Karene Gaile Boone, NP
• Molly Bracken, M.A.
• Monica L Branson, OTR/L

• Psychiatric/Mental Health Nurse Practitioner in Loganville, GA
• Providers in Loganville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.