Individual
MATTHEW DANE BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
908 W PINE ST, HATTIESBURG, MS 39401-4262
(601) 268-5850
(601) 544-3545
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 544-1261
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R885021
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880352
—
MS
Enumeration date
09/11/2015
Last updated
07/19/2024
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