Provider Demographics
NPI:1639995178
Name:BOLER, RASHADA KEADRIA (BSN, RN, CCRN)
Entity type:Individual
Prefix:
First Name:RASHADA
Middle Name:KEADRIA
Last Name:BOLER
Suffix:
Gender:F
Credentials:BSN, RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BALEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1270
Mailing Address - Country:US
Mailing Address - Phone:601-416-4417
Mailing Address - Fax:
Practice Address - Street 1:201 BALEIGH DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-1270
Practice Address - Country:US
Practice Address - Phone:601-416-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS917462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse