Kevin J Bolland, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10003177 Issued in WA

Practice address

10828 Gravelly Lake Dr SW
Lakewood, WA 98499-1334

Phone

(360) 436-6594

NPI assigned

Feb 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Rainier Internal Medicine LLC

  • Primary Care Clinic/Center
  • Lakewood, WA
  • NPI 1972735157
  Medicare reassignment
• Lake Tapps Family Medicine, PLLC

  • Family Medicine Physician
  • Lake Tapps, WA
  • NPI 1245406032

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1962543033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19414 126TH ST E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916063",
            "telephone_number": "253-740-3245",
            "fax_number": "253-826-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10828 GRAVELLY LAKE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991334",
            "telephone_number": "360-436-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLAND",
        "first_name": "KEVIN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003177",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10003177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "188614",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale C Bobb, DDS
• Mary Katherine Bock, LPN
• Elisha Boetel
• Angela Boites
• Mason Warren Bolieu
• James Travis Bolt, ARNP
• Luke Raymond Bolt, MS, RDN, ACSM EP-C
• Annapurrnaah Bommareddy, MS CCC-SLP
• Emily Bonaventura
• Cheryl Anne Bond

• Physician Assistant in Lakewood, WA
• Providers in Lakewood, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.