Provider Demographics
NPI:1063928232
Name:BOLTON, JERI ANN (AS,RRT,NPS,CPFT)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:AS,RRT,NPS,CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 31ST ST SW
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5393
Mailing Address - Country:US
Mailing Address - Phone:903-449-9665
Mailing Address - Fax:
Practice Address - Street 1:365 31ST ST SW
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5393
Practice Address - Country:US
Practice Address - Phone:903-449-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56319227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty