Individual
KENEISHA BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 N. CYPRESS ST., KOUNTZE, TX 77625-7762
(409) 679-6173
Mailing address
PO BOX 1208, KOUNTZE, TX 77625-1208
(409) 679-6173
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
897519
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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