Individual
STEPHEN BOLIVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
401 SOUTHCREST CIR STE 202, SOUTHAVEN, MS 38671-6719
(662) 536-2281
(901) 763-3694
Mailing address
3158 MEADOWS WAY, HERNANDO, MS 38632-1090
(601) 651-2832
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
888641
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07029064
—
MS
Enumeration date
08/29/2013
Last updated
11/17/2025
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