Provider Demographics
NPI:1497630818
Name:BOLYARD, DESTINY ROSE
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ROSE
Last Name:BOLYARD
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 1:1221 BROOKS LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8453
Mailing Address - Country:US
Mailing Address - Phone:681-209-8124
Mailing Address - Fax:
Practice Address - Street 1:503 MORGANTOWN AVE STE 120
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4384
Practice Address - Country:US
Practice Address - Phone:304-363-7375
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker