Individual
KYLE BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20460 ANACONDA RD, FORT DRUM, NY 13603
(480) 387-0619
Mailing address
20460 ANACONDA RD, FORT DRUM, NY 13603
(480) 387-0619
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/13/2021
Last updated
03/18/2025
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