Provider Demographics
NPI:1881464238
Name:BOLDING, KIMBERLY PAIGE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:BOLDING
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 1:1212 E KIRK ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3607
Mailing Address - Country:US
Mailing Address - Phone:580-322-6527
Mailing Address - Fax:580-326-8047
Practice Address - Street 1:1212 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3607
Practice Address - Country:US
Practice Address - Phone:580-322-6527
Practice Address - Fax:580-326-8047
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist