Bolton Clinic, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R652075 Issued in MS

Legal business name

BOLTON CLINIC, PLLC

Practice address

2001 Airport Rd N
Suite 204
Flowood, MS 39232-8827

Phone

(601) 932-3191

Fax

(601) 936-7193

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. William F Krooss II, MD

Title

Managing Member

Phone

(601) 932-3191

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1851429971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W MADISON ST",
            "city": "BOLTON",
            "state": "MS",
            "postal_code": "39041",
            "telephone_number": "601-866-7723",
            "fax_number": "601-866-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 AIRPORT RD N",
            "address_2": "SUITE 204",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328827",
            "telephone_number": "601-932-3191",
            "fax_number": "601-936-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLTON CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "KROOSS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "601-932-3191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R652075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Flowood, MS
• Providers in Flowood, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.