Individual
MR. BARRY WARRIS BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
712B LOUISIANA AVE, BOGALUSA, LA 70427
(985) 750-4511
(985) 732-1095
Mailing address
712B LOUISIANA AVE, BOGALUSA, LA 70427
(985) 750-4511
(985) 732-1095
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
03679828
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03679828
DRIVER LICENSE
LA
Enumeration date
06/09/2016
Last updated
06/09/2016
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