Provider Demographics
NPI:1831506674
Name:BOLDEN, KARLA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S SUMMITT ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2565
Mailing Address - Country:US
Mailing Address - Phone:870-510-1140
Mailing Address - Fax:
Practice Address - Street 1:204 S SUMMITT ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2565
Practice Address - Country:US
Practice Address - Phone:870-510-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator