Individual
SHARON P BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1701 RENAISSANCE BLVD, SUITE 110, EDMOND, OK 73013-3086
(405) 844-4978
(405) 844-0562
Mailing address
1701 RENAISSANCE BLVD, SUITE 110, EDMOND, OK 73013-3086
(405) 844-4978
(405) 844-0562
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1355
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OK700080
MEDICARE TPAN
OK
Enumeration date
07/12/2006
Last updated
05/11/2017
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