Individual
MR. BOBBY D. BOLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AFNP
Contact information
Practice address
402 RECOVERY RD, KENNETT, MO 63857-3235
(573) 888-0274
(573) 888-1225
Mailing address
PO BOX 747, 402 RECOVERY ROAD, KENNETT, MO 63857-0747
(573) 888-0274
(573) 888-1225
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
152914
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152914
STATE LISCENCE
MO
Enumeration date
03/24/2009
Last updated
03/24/2009
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