Heather Diana Bolton, PA
Individual provider Active NPI Physician Assistant · Lebanon, TN
NPI 1831133727 · NPPES record last updated Oct 3, 2007
Key facts
- NPI
- 1831133727
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA1192 (TN)
- Practice address
- 307 F West Main St
Lebanon, TN 37087 - Phone
- (615) 449-4151
- Fax
- (615) 449-1994
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA1192 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agapee Surgical Associates Inc. | Past | Accepting new patients | |
| Lebanon Health Care Center | Physician Assistant | Past | Accepting new patients |
| Lung Consultants PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1192 | TN | Yes |
Addresses
Primary practice location
307 F West Main St
Lebanon, TN 37087
Mailing address
PO Box 3322
Lebanon, TN 37088
Phone (615) 449-4151
Other names
- Mrs. Heather Diana Thompson
Other providers in Lebanon, TN
- Kristy M Blaney
- Jaime Christen Blaylock
- Laura F Boggan
- Tiffany Marie Bogle
- Nick Boles
- Carolyn Lee Bond
- Tyler Bott
- Botts Diabetes & Endocrinology
- Dara W Botts
- John R Boucher
All providers in Lebanon, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.