Individual
MRS. TONYA JOY BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6026 BATTIEST PICKENS RD, BROKEN BOW, OK 74728-5033
(580) 241-5294
(580) 241-5739
Mailing address
PO BOX 180, BATTIEST, OK 74722-0180
(580) 241-5294
(580) 241-5739
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11850
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200026970A
—
OK
Enumeration date
12/15/2006
Last updated
04/24/2015
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