Provider Demographics
NPI:1013358530
Name:BOULTS, DEIDRE ALLEN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:ALLEN
Last Name:BOULTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:MARSHA
Other - Last Name:ALLEN BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 COUNTY ROAD HWY 304
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040
Mailing Address - Country:US
Mailing Address - Phone:205-319-8000
Mailing Address - Fax:205-319-8000
Practice Address - Street 1:72 CO RD HWY 304
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040
Practice Address - Country:US
Practice Address - Phone:205-319-0000
Practice Address - Fax:205-319-8004
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily