Provider Demographics
NPI:1407672512
Name:BOLTZ, KAYLA J (FNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:J
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:J
Other - Last Name:LAPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:MT
Mailing Address - Zip Code:59436-0684
Mailing Address - Country:US
Mailing Address - Phone:406-899-6222
Mailing Address - Fax:
Practice Address - Street 1:900 6TH ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3207
Practice Address - Country:US
Practice Address - Phone:406-727-3242
Practice Address - Fax:406-727-3161
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT245583363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care