Individual provider Active NPI

Tonya Anne Boliver, RN

  • Psychiatric/Mental Health Registered Nurse
  • Watertown, NY
National Provider Identifier
1811772064
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
578776 Issued in NY
Practice address
482 Black River Pkwy
Watertown, NY 13601-2416
Phone
(315) 782-1777
Fax
(315) 782-8628
NPI assigned
Aug 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 578776 NY Primary

Addresses

Primary practice location

482 Black River Pkwy
Watertown, NY 13601-2416

Mailing address

482 Black River Pkwy
Watertown, NY 13601-2416
Phone (315) 782-1777

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
578776NYMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Transitional Living Services, Inc CurrentSince Sep 5, 2023 Accepting new patients
Thrive Wellness and Recovery, Inc CurrentSince Aug 4, 2024 Accepting new patients

Locations

482 Black River Pkwy
Watertown, NY 13601
Phone (315) 782-1777

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1811772064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 BLACK RIVER PKWY",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012416",
            "telephone_number": "315-782-1777",
            "fax_number": "315-782-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 BLACK RIVER PKWY",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012416",
            "telephone_number": "315-782-1777",
            "fax_number": "315-782-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIVER",
        "first_name": "TONYA",
        "middle_name": "ANNE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NY",
            "license": "578776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.

Verify at the official NPI Registry.