Active NPI
Jeremy Bolden, ATC,LAT
- Athletic Trainer
- Little Elm, TX
National Provider Identifier
1801387667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT5165
- Practice address
- 3449 Bluewater Dr
Little Elm, TX 75068-3425 - Phone
- (337) 316-1948
- NPI assigned
- May 28, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT5165 | TX | Primary |
Addresses
Primary practice location
3449 Bluewater Dr
Little Elm, TX 75068-3425
Mailing address
3449 Bluewater Dr
Little Elm, TX 75068-3425
Phone (337) 316-1948
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 |
|---|---|---|---|
| AT5165 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527465600000",
"number": "1801387667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3449 BLUEWATER DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750683425",
"telephone_number": "337-316-1948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3449 BLUEWATER DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750683425",
"telephone_number": "337-316-1948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDEN",
"first_name": "JEREMY",
"credential": "ATC,LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-28",
"last_updated": "2018-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT5165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Elm, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.