Provider Demographics
NPI:1407421332
Name:BOLES, MARGARET HUFFMAN (PA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:HUFFMAN
Last Name:BOLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:KATHERINE
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3677 COOPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0176
Mailing Address - Country:US
Mailing Address - Phone:903-576-4611
Mailing Address - Fax:
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 302A
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2387
Practice Address - Country:US
Practice Address - Phone:903-614-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330854225100000X
TXPA18544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4248932Medicaid
TX8PM876OtherBCBS